Atlas Measurements Petazzoni Jaeger

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Atlas of Clinical Goniometry
and Radiographic Measurements
of the Canine Pelvic Limb
Print 12/2008 - UPALTR 067
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2
Introduction by the Author

Goniometry is the science of measuring the angles.
I was happy to accept the proposal from Merial to create this Atlas becau-
se I think goniometry is a skilled knowledge that is indispensable for the
orthopedic veterinarian.
I received my first armed goniometer from Dr. Aldo Vezzoni during one of
my first days attending his ambulatory service as a new graduate. I was eager to expand my kno-
wledge and practical applications in veterinary orthopedics. Dr. Vezzoni told me: "Take this
Massimo, this will be useful to you". I thanked him and I put the goniometer in the chest pocket of
my brand white new lab coat. I never thought that the goniometer would be the most useful instru-
ment I would use in the following years, second only to my Mac and the x-ray machine. It was 1998.
I started using the goniometer to make radiographic measurements such as the Norberg angle and
the Distraction Index. I subsequently learned by the example of Aldo Vezzoni, Professor Carlo Maria
Mortellaro, and Professor Mauro Di Giancamillo over the following years. In 1998, while attending the
Ilizarov course with Dr. Antonio Ferretti and Dr. Marcellin-Little, I learned how to measure deformi-
ties of the thoracic limb and in 2000, Dr. Barclay Slocum opened my mind to the alignment of the
pelvic limb. I am very grateful to all these extraordinary teachers, but my real passion for goniome-
try was conceived from an iatrogenic malalignment I caused in the late 1990s. As a new graduate, I
was performing an apparently easy surgery, removing a intramedullary femoral Kuntscher pin that
was the cause of endostitis, pain, and lameness in an old female German Shepherd dog. Because of
an inadequate interpretation of the radiographs, I did not realize that the pin that was inserted in the
femur many years before to stabilize a pediatric fracture was no longer in the center of the femoral
canal, but it was in the medial cortex of the bone. During my attempted removal of the pin through
the interchanteric fossa, the femur broke in thousand pieces (a highly comminuted femoral fractu-
re resulted). I stabilized the fracture with a bridging buttress plate applied to the lateral cortex. The
fracture healed within a few weeks, but the gait was forever abnormal because of an iatrogenic inter-
nal torsion incurred at the time of fracture reduction. That case of genu valgum started my personal
fascination with malalignment and the relationships between anatomtic structures and their mea-
surements to obtain a correct diagnosis.
Over the years, I have performed numerous studies dedicated to the alignment of both the front
and hindlimbs thanks to the availability of goniometry and radiographs and to the more technolo-
gical and sophisticated equipment, particulary the CT scan. The study of limb alignment in cani-
ne medicine, however, is only in its beginning. In addition, the great variability of intraspecies mea-
surements coming from hundreds of breeds confounds the concept of normality.
The goal of this atlas is to give a practical instruction to the goniometer, a complement to the tra-
ditional physical examination that could be of help to the orthopedic surgeon in their daily work
providing a basis for dealing with the most common clinical and radiographic measurements.
I thank my wife Elena and toads, Camilla and Riccardo, to excuse me for all the time I took from
our time together while I was writing this atlas. I would also like to thank my partner Francesco for
his continual and constant encouragement. Rodolfo Colpo for his precious support. My ackno-
wledgments would not be complete without mentioning Gayle. Without her help this second edition
would not have been possible. Looking forward for the Canine Thoracic Limb Atlas...
Massimo Petazzoni
4
Introduction by the Co-Author

I was delighted when Massimo asked me to participate on this project focu-
sing on clinical goniometry.
My first experience with angular limb deformities and orthopedics in gene-

ral was a summer research project evaluating the morphology of torsional
deformities in limb ostriches. This was my introduction to the assessment
of normal and abnormal limb alignment with an appreciation for its affect
on gait. I did not realize it at the time, but this early work was the spark for my interest in ortho-
pedic surgery.
It was during my surgical residency, that I learned to use a goniometer and that goniometry was
a staple of a good orthopedic examination. It was at this time under the tutelage of Dr. Marcellin-
Little we performed a validation study of goniometry in Labrador Retrievers establishing referen-
ce values for normal joint range of motion. To illustrate the infancy of goniometry in veterinary
medicine, this was the first study validating the repeatability of the method and determining nor-
mal reference joint angles. It was not until I left my residency to go into practice did I really appre-
ciated the value of goniometry in clinical patients. So much in fact, that on a sunny weekend in
Southern California, I coerced some of the technicians into helping me perform a goniometry vali-
dity study in cats to establish reference values in this species. We conducted this study and con-
cluded that not only is goniometry valid in the cat, but also that cats are not Labradors, and
"speed" goniometry is reliable, another example of how easy the method is to perform.
The use of the goniometer is obvious when evaluating patients with angular or torsional limb
deformities to determine the amount of deformity present both clinically and radiographically, as
well as plan, performed and evaluation the correction of the deformity. However, it is a very good
method of quantitating a baseline value in the evaluation of osteoarthritic joint disease as well as
its response to time and treatment and is not limited to use by orthopedic surgeons.
It is with this atlas that we hope to illustrate the methodology of clinical goniometry in the asses-
sment of joint range of motion as well as during standing as part of a routine physical examina-
tion. We give an introduction and foundation for the evaluation of limb alignment and angular limb
deformities reviewing normal anatomy and terminology, and standardizing various methods for
the assessment of limb alignment and radiographic uses of goniometry.
I would like to express my thanks to Massimo Petazzoni for my involvement in this project and
hopefully many others. Massimo truly exemplifies the meaning on simpatico. I would also like to
acknowledge Dr. Denis Marcellin-Little who has been monumental in my career pushing me to
always think one step further and Dr. Simon Roe for teaching me "what works”, in surgery and life
in general.
Gayle Jaeger
6
Introduction by the Editor

Outside of a dog, a book is a man’s best friend
Inside of a dog it’s too dark to read.
Groucho Marx
On face value, it could be considered an anachronism to add clinical goniome-

try as a diagnostic method in light of more technical and sophisticated moda-
lities such as CT scan and MRI which offer inumerable diagnostic possibilities.
Considering the phrase of Groucho Marx, one should ask themselves how a simple armed goniome-
ter could be of help to shed light on what is happening inside our four-legged patients. However,
recent clinical studies confirm without question, the unequivocal usefulness of this clinical examina-
tion in veterinary medicine as it has been in human medicine for a long time. The measurement of
the joint angles makes the clinical examination more rich of new elements of analysis of the functio-
nality of the joints and allows to evaluation the efficacy of the surgical, pharmacologic or physiothe-
rapeutic treatments adopted. This examination, made with a simple armed goniometer, is easy, repe-
titive, non -invasive and inexpensive. Also, goniometry can be useful to have the owners have increa-
sed responsibility and motivation following the prescription of indicated therapies, it is rewarding to
educate the owners on improvements with treatment that have been performed, and not least impor-
tantly, to schedule the necessary repetitive clinical visits for treatment. The knowledge of these
advantages has motivated the creation of this Atlas, with the objective to supply the readers indispen-
sable elements beneficial to any physical examination.
The reading of the first three chapter headings:" The Elements of Goniometry", "The Goniometer" and
"Terminology and Definitions", gives a basic understanding in methodology for the subsequent chap-
ters. The goniometric evaluation requires a basic knowledge of elementary concepts in geometry and
terminology necessary to define accurate position of anatomic structures in space.
For the creation of the chapter: "Clinical Goniometery" we took advantage of a primary source, a
recent study by Jaeger and Marcellin-Little in virtue of its accuracy and thoroughness of content.
The usefullnes of goniometry is not exhausted in the clinical appraisal of the amplitude of move-
ments, but extends also to the reading of the radiographic examination. Therefore, we have decided
to place next to the clinical goniometry, the description of the main radiographic measurements of
the pelvic limb, a subject of sure interest to orthopedic veterinarians dedicated to the correction of
angular limb deformities.
I conclude this introduction with a particular thanks to Massimo & Gayle for their extraordinary and
infectious determination and meticulous dedication to a task. After reading over 100 articles, and a
hundred of hours working side by side on the job, with many impossible deadlines and more than 100
photographs and designs they created, to them goes all my esteem.
Rodolfo Colpo - Merial Italia
I want to express my thanks to those who have contributed to the creation of the Atlas and have gonio-
meters, its natural compliment:
Antonio Ferretti: ECVS Practioner, Milano, Italy
Bruno Peirone: University of Torino, Faculty in Veterinary Medicine
Diane A. Fagen: American Veterinary Medical Association
Giuseppe Anelli: AGF Italia
Marisa Liberali: AGF Italia
Mattia Masse: G&P communication
Michele Musso: University of Torino, Bibiolographer of the Faculty of Veterinary Medicine
Rainder Flecks-Franke:Kleintierpraxis - Journal of DGK-DVG. M. &H. Shaper GmbH.
7 Index
Table of Contents
1 - Elements of Goniometry 10
2 - The Goniometer with Arms 14
Description 14
The measurement of angles 15
The use of concentric circles - the Mose method 16
3 – Terminology and Definitions 18

Anatomic Planes 18
Movements 19
Anatomic Axis
Mechanical Axis
Bone Angular Deformities
Joint Angular Deformities 20
4 - Clinical Goniometery 22
Introduction 22
Procedure 23
Shoulder 25
Elbow 26
Carpus 27
Hip 28
Stifle 29
Tarsus 30
Normal standing joint angles of the hindlimb 31
5 - Radiographic Measurements of the Femur 34

Radiographic anatomy in the frontal plane 34
Radiographic anatomy in the sagittal plane 35
Radiographic anatomy in the transverse plane 36
Mechanical and anatomic axes in the frontal plane 37
Mechanical and anatomic axes in the sagittal plane 38
Joint orientation lines in the frontal plane 39
Proximal and distal anatomic axes of the frontal plane as defined by Tomlinson 40
Proximal and distal anatomic axes in the sagittal plane
as defined by Petazzoni 41
Nomenclature of joint angles in the frontal plane as defined by Paley 42
Index 8
Mean values of the joint angles of the femur in the frontal plane reported in the literature 43
Joint angles with respect to the anatomic axis in the sagittal plane
as proposed by the authors using nomenclature of Paley 44
Joint angles with respect to the mechanical axis in the sagittal plane
as proposed by the authors using nomenclature of Paley 45
Femoral neck angle or angle of inclination as described by Tomlinson 46
Femoral neck angle or angle of inclination as described by Hauptman, method A 47
Femoral neck angle or angle of inclination as described by Hauptman, method B 48
Femoral neck angle or the angle of inclination 49
Femoral neck angle or the angle of inclination and anatomic axes: the SYMAX method 50
Values of the the femoral neck angle or angle of inclination reported
in the literature using the SYMAX method 51
Measurement of femoral torsion and angle of anteversion of the femoral neck 52
Measurement of the femoral torsion angle or angle of anteversion
of the femoral neck with the biplanar or trigonometric method 53
Estimation of the femoral torsion comparing proximal and distal aspect of the bone 55
6 - Radiographic Measurements of the Tibia 60

Radiographic anatomy in the frontal plane 60
Radiographic anatomy in the sagittal plane 61
Mechanical and anatomic axes in the frontal plane 62
Mechanical and anatomic axes in the sagittal plane 63
Joint orientation lines in the frontal plane 64
Joint orientation lines in the sagittal plane 65
Nomenclature of the joint angles in the frontal and sagittal planes
as described by Paley 66
Tibial Plateau Angle and mechanical Caudal Proximal Tibial Angle (mCaPTA) 67
Mean values of the joint angles in the frontal and sagittal planes 68
Estimation of the tibial torsion comparing proximal and distal aspect of the bone 69
7 - Radiographic Measurements of the Hip 74

Radiographic anatomy. Standard ventro-dorsal projection (OFA - FCI) 75
Norberg Angle 77
Radiographic anatomy. The Dorsal Acetabular Rim projection (DAR) 79
Measurement of the DAR angle (Dorsal Acetabular Rim) or angle
of inclination of the dorsal acetabular rim 80
Radiographic anatomy. Ventro-dorsal projection with distraction 83
Measurements to calculate the distraction index (DI) 84
8 – References 88
Elements of Goniometry 10
1 - ELEMENTS OF GONIOMETRY
Below is a comprehensive description of some concepts of geometry which are essential for
the correct excecution and interpretation of measurements
Straight line
A line is infinite and straight. A line is a set of continuous points that extend indefinitely in
either direction. A line segment is a portion of a straight line between a point of origin (A)
and a second point (B) and is therefore referred to as line AB. (Figure 1).
A B
Figure 1
Circle
The circle is a shape formed by points located at a fixed distance, the radius, from a center
point. The circle includes its inner part and its border is called the circumference. The dia-
meter is the distance across the circle passing through the center joining two points on the
circle. (Figure 2)
circumference
circle
diameter
center
radius
Figure 2
11 Elements of Goniometry
Angle
An angle is defined as two line segments having a common origin. The two line segments
form the sides of the angle while their origin constitutes the apex of the angle (A) (Figure 3).
Figure 3
An angle can further be described based on the direction of the angle beginning from the
initial position of line segment AB to the final position at line segment AC. Line AB is refer-
red to the origin, while line AC is referred to as the extremity of angle A.
The orientation of the angle is considered positive is the rotation of the angle is in a coun-
terclockwise direction and negative if the rotation is in a clockwise direction.
Figure 4 B
C
extremity origin
+ -
A B A C
origin extremity
The unit of measure of angles is based on the sexagesimal system of measurement (the
most commonly used) and is indicated in degrees with the symbol (°), and represents
1/360 of a complete angle turn or circle. Degrees are subdivided into minutes (') and
seconds("). Each minute is a 1/60 of a degree and each second is 1/60 of a minute.
Measurements used for orthopedics are generally expressed in degrees without the sub-
division into minutes and seconds.
Figure 5
Right 90° ANGLE VALUE
Acute α < 90°
Right α = 90°
Acute Obtuse
Obtuse 90°<α <180°
Plane α = 180°
0 Plane 180° Circle α = 360°
Circle 360°
Elements of Goniometry 12
Paired angles relative to the fundamental angle are described by their position and sum-
mation to the fundamental angle. Angles are referred to as complimentary angles if the
summation with the fundamental angle is equal to 90° or a right angle. Paired angles are
referred to as supplementary if the summation of the two angles is equal to 180° or a
straight line. Paired angles are referred to as explementary if the summation of the angles
is equal to 360° or a complete circle.
Complementary α + β = 90°
α + γ = 180°
α + Δ = 360°
γ Supplementary
Δ Explementary
Figure 6
Tangent
The tangent to a circle is a line (tg) that incorporates one point P along the circumference
of the circle and whose direction is perpendicular to the radius of the circle at the circle-
line intersection.
r
tg
90°
Figure 7
The Goniometer with arms 14
2 - THE GONIOMETER WITH ARMS
Description
The goniometer is an instrument used to measure joint angles and joint range of motion.
The goniometer is composed of a reference arm (Arm A) and a movement arm (Arm B).
The two arms are connected by a hinge. This fulcrum allows rotation of the arms around
each other. Around this hinge, the movement arm (Arm B) has a graduated goniometric
scale (0 +/- 180°) used to quantitate the angle degree between the two arms.
5
4
Arm A Figure 8
3
6 7
1 Millimeter ruler (0-350mm)

2 Millimeter ruler (0-45mm)
3 Graduated goniometric scale 0 +/- 180°
with two degree increments
4 Central point (point of rotation) of the goniometer
Arm B 5 Axis of Arm A (Reference Arm) with an index line
for goniometric reading
6 Axis of Arm B (Movement Arm)
7 Concentric circles (10-15-20-25-30mm diameter)
8 Viewfinder at the center of the concentric circles
9 Graduated goniometric scale 0 to 28°
2 with one degree increments
15 The Goniometer with arms
The measurement of angles

The example refers to the measurement of angle α and its supplementary angle β (Figure 9).
1. Place the center of rotation (fulcrum) of the goniometer at the apex of the angle V and align
the axis of Arm A with the side of the angle. (Figure 10)
2. Move the axis of Arm B until it coincides with the other side of the angle V.
3. The amplitude of angle α is determined by the goniometric reading along the axis of Arm A
(Blue arrow - 46°)
4. The amplitude of supplementary angle β is determined by the goniometric reading along the
opposite side (180°) of the goniometric reading of Arm A (Red arrow - 134°)
Figure 9
V
Arm B
Amplitude angle α
Arm A
Figure 10
Amplitude angle β
The Goniometer with arms 16
The use of concentric circles - the Mose method

The method of Mose uses concentric circles to characterize and find the center of circular
structures such as the center of the femoral head or acetabulum. (Mose K, 1980)
1. Position the viewfinder, the center of the series of concentric circles, over the anatomic
structure of interest.
2. Concentrate on the circle that best approximates the dimension of the anatomic struc-
ture.
3. Once the anatomic structure is aligned with one of the concentric circles, the viewfin-
der is used to mark the center of the anatomic structure of interest.
Figure 11
Terminology and Definitions 18
3 - TERMINOLOGY AND DEFINITIONS

Anatomic planes
The position of the part of the body of interest can be identified spacially in reference to three
anatomic planes which are perpendicular to each other: the sagittal plane, the frontal or coro-
nal plane and the transverse plane (Figure 12).
Sagittal plane
Figure 12
Transverse The orientation of Massimo Petazzoni with
plane respect to the three orthogonal anatomic
planes (Modified by Carlo Rambaldi 2008).
Frontal plane
• The sagittal plane

The sagittal planes are oriented in a cranio-caudal position and divide the body into left and
right parts. The median sagittal plane divides the head, limbs or body into equal left and right
halves. The sagittal planes are parallel to the median plane and are referred to as parame-
dian planes. The anatomic part closest to the median plane or center of the body is termed
medial while the anatomic part farthest from the median plane is termed lateral.
• The frontal plane

The frontal or coronal plane courses in a lateral-lateral orientation dividing the body into a
cranial or anterior portion and a caudal or posterior portion. The anatomic part closest to
the anterior portion of the animal, conventionally toward the head, is termed cranial. On the
contrary, the anatomic part of the animal closest to the posterior portion of the animal is
termed caudal.
• The transverse plane

The transverse plane divides the body of the animal into a superior or dorsal part and a infe-
rior or ventral part. The anatomic part that is closest to the vertebral spine is termed pro-
ximal whereas the anatomic part of the body that is farthest from the veterbral spine is ter-
med distal.
In the manus and pes, the term dorsal refers to the superior or upper surface of the foot.
Palmar and plantar refers to the inferior or under surface of the manus and pes of the front
limb and hindlimb, respectively.
19 Terminology and Definitions
Movements
The motion of the body is defined by the direction of movement of the anatomical parts in rela-
tion to the anatomic planes. In the frontal plane, motion of the limbs are termed either abduction
or adduction. Abduction occurs when a part of the body is moved away from the median sagittal
plane. Conversely, adduction when the anatomic part is moved toward the median sagittal plane.
In the sagittal plane, movement of the limb is defined as either flexion or extension. Flexion
occurs when the angle between the limb segments diminishes. and is moved toward the
body. Extension occurs when the angle of the segments of the limb increases and the limb
moves away from the body.
The movement around the transverse plane is referred to as rotation, either internal or external.
Anatomic axis
The anatomic axis of a bone segment is a line that passes through the center of the bone
through the epiphysis, diaphysis and metaphysis. This line can be either curved or straight
depending on the anatomy/conformation of the bone and joins the center of the two articular
surfaces. The anatomic axis is a single curved line that follows the center of the bone, howe-
ver for a practical view we will refer to separate proximal and distal anatomic axes. These
measurements are important for the evaluation of abnormally conformed bones.
Mechanical axis
The mechanical axis is a straight line connecting the center of the proximal and distal
joints.
Bone Angular Deformities
Figure 13 Figure 14 Figure 15
• Varus Deformity of the Bone

Deformity in which the proximal or distal end of a bone is deflected inward toward the sagit-
tal median plane of the body. (Figure 13).
Terminology and Definitions 20
• Valgus Deformity of the Bone

Deformity in which the proximal or distal end of a bone is deflected outward away from the
sagittal median plane of the body. (Figure 14).
• Procurvatum Deformity of the Bone

Deformity in which the proximal or distal end of a bone is deflected caudally (Figure 15).
• Recurvatum Deformity of the Bone

Deformity in which the proximal or distal end of a bone is deflected cranially.
• Torsional Deformity of the Bone

Torsion is the internal or external deviation around the long axis of the bone. We define torsion
conventionally in a proximal to distal direction and the torsion can be either internal or external.
Joint Angular Deformities

• Valgus Deformity of the Joint
The abnormal relationship between the contiguous anatomic axes of the bone segments
directly above and below the joint deflecting the distal limb laterally.
• Varus Deformity of the Joint

directly above and below the joint deflecting the distal limb medially.
• Procurvatum Deformity of the Joint

directly above and below the joint deflecting the distal limb caudally.
• Recurvatum Deformity of the Joint

directly above and below the joint deflecting the distal limb cranially.
• Rotational Deformity of the Joint

Rotation is the internal or external deviation of a inside a joint (outside of a single bony com-
partment and along the joint plane). For example supination or pronation of the results in
rotation of the distal segment of the arm relative to the upper arm.
Clinical Goniometry 22
4 - CLINICAL GONIOMETRY
Introduction
Clinical goniometry, the measurement of joint angles, is an important part of a comprehen-
sive orthopedic examination.
This method allows for quantification of joint range of motion and relative function of the
joint. Goniometry is a simple noninvasive procedure which is easy to perform using the
orthopedic measuring arms of the goniometer.
In the presence of joint pathology, in particular osteoarthritic disease, the change in joint
flexion/extension angles and overall range of motion can give an indication to the severity
of the pathology as well as provide a baseline for disease progression.
For the orthopedic surgeon, the assessment of joint range of motion can be used to deter-
mine the appropriate surgical intervention and the effectiveness of that treatment.
Similarly, the assessment of joint range of motion can be used to determine the effective-
ness of pharmacologic and rehabilitative treatments on disease progression.
The goniometric method can be performed with the animal either standing or in lateral
recumbency. It is recommended that the procedure be performed in a similar manner each
time for improved accuracy and repeatability.
Similarly, it is important to consider the impact of pain or discomfort of the animal when
performing range of motion measurements. Animals painful with joint pathology can resist
and therefore limit the extremes of range of motion compared to the contralateral unaffec-
ted joint or animals relaxed under the influence of sedation or anesthesia.
Reference values for joint range of motion have been determined from healthy Labrador
Retrievers and German Shepherds (Table 1). Though joint angles can vary by breed, confor-
mation, age and disease status, these values can be used as a baseline for extrapolation.
An unaffected contralateral joint can also be used as a reference for normal range in motion
in a particular animal if available.
Mean value of measurements obtained for various joints by use of a Plastic Goniometer in 12 German Shepherd
Dogs, compared with values obtained in 16 Labrador Retrievers
GERMAN SHEPHERD DOGS LABRADOR RETRIEVERS
JOINT VARIABLE
(°) (°)
Flexion 34 32
Carpus Extension 198 196
Range of motion 164 164
Flexion 25 36
Elbow Extension 155 165
Flexion 47 57
Shoulder Extension 159 165
Flexion 30 39
Tarsus Extension 149 164
Flexion 33 42
Stifle Extension 153 162
Flexion 44 50
Hip Extension 155 162
Table 1. From: Thomas TM, et al. AJVR 2006
23 Clinical Goniometry
Procedure
1. Identify the center of rotation of the joint by flexing and extending the joint. The center of
rotation of the joint is a point that does not move through joint range of motion.
2. Position the center of rotation of the goniometer over the center of rotation of the joint.
3. Align and stabilize the reference arm of the goniometer (Arm A) over the axis of the bone
proximal to the joint being measured. Align the motion arm of the goniometer (Arm B)
over the axis of the bone distal to the joint.
4. With the arms of the goniometer aligned with axes of the bones proximal and distal to
the joint, completely flex the joint to find the Angle of Flexion, AF. This angle can be quan-
tified by reading the measurement on the goniometer along the axis of the reference
arm. The amplitude of the Angle of Flexion in Figure 16 is measured along Arm A and is
demonstrated by the red arrow. In this example, the Angle of Flexion is 32°.
5. To determine the Angle of Extension, AE, completely extend the joint while stabilizing the
arms of the goniometer along the axes of the bones proximal and distal to the joint. The
amplitude of the Angle of Extension in Figure 17 is measured along Arm A and is demon-
strated by the red arrow. In this example, the Angle of Extension is 140°.
AF
AE
Figure 16 - Measurement of the Angle of Figure 17 - Measurement of the Angle of

maximum Flexion of the Carpus (in this maximum Extension of the Carpus (in this
example, 32 °) example, 140 °).
6. For angles greater than 180°, it is necessary to add 180° to the resultant value demon-
strated by the blue arrow. In the example below, the amplitude read along Arm A as
demonstrated by the blue arrow and is 12°. The Angle of Extension is, therefore, 192°
(12° + 180°).
AE
Figure 18 - The measurement of the maximum Angle of

Extension of the Carpus (in this example 192° =12° +180°).
7. To determine the amplitude of the Range Of Motion (ROM) or Angle of Articulation (AA),
the Angle of Flexion (AF) is subtracted from the Angle of Extension (AE).
ROM=AA=AE-AF.
For example, if the Angle of Extension (AE) of the carpus is 196° and the Angle of Flexion (AF)
is 32°, AA=192-32=160° Range Of Motion.
AE = 192°
AA = 192° - 32° = 160°
AF = 32°
Shoulder
Angle of maximum Flexion Angle of maximum Extension
Figure 19 Figure 20
POSITIONING OF THE GONIOMETER

Arm A (red line): The axis of the scapula is defined by the spine of the scapula.
Arm B (blue line): The longitudinal axis of the humerus is defined by a straight line connecting the
lateral epicondyle of the humerus to the insertion of the infraspinatus muscle on the greater
tubercle of the humerus.
Jaegger G. et al. 2002
Elbow
Figure 21 Figure 22

Arm A (red line): the longitudinal axis of the humerus is defined by a straight line connecting the
lateral epicondyle of the humerus to the insertion of the infraspinatus muscle on the greater
tubercle of the humerus.
Arm B (blue line): The longitudinal axis of the antebrachium is defined by a straight line connec-
ting the styloid process of the ulna to the lateral epicondyle of the humerus.
Carpus
Figure 23 Figure 24

Arm A (red line): The longitudinal axis of the antebrachium is defined by a straight line con-
necting the styloid process of the ulna and the lateral epicondyle of the humerus.
Arm B (blue line): the longitudinal axis of the metacarpals is defined by a line parallel to meta-
carpal bones 3 and 4.
Hip
Figure 25 Figure 26

Arm A (red line): The axis of the pelvis is defined by a line at the level of the greater trochanter
of the femur, parallel to a line connecting the dorsal margin of the iliac tuberosity to the dorsal
margin of the ischiatic tuberosity (dashed line).
Arm B (blue line): The longitudinal axis of the femur is defined by a straight line connecting the
lateral epicondyle of the femur to the center of the greater trochanter.
Stifle
Figure 27 Figure 28
POSTIONING OF THE GONIOMETER

Arm A (red line): the longitudinal axis of the femur is defined by a line connecting the greater tro-
chanter to the center of the lateral epicondyle of the femur.
Arm B (blue line): The longitudinal axis of the tibia is defined by a line connecting the lateral mal-
leolus to the cranial-caudal center of the proximal tibia at the level of the tibial crest.
Tarsus
Figure 29 Figure 30

Arm A (red line): the longitudinal axis of the tibia is defined by a line connecting the lateral mal-
leolus to the cranio-caudal center of the proximal tibia at the level of the tibial crest.
Arm B (blue line): the longitudinal axis of the metatarsi is a line parallel to the longitudinal axes
of metatarsal bones 3 and 4.
Normal standing joint angles of the hindlimb
Figure 31
STANDING ANGLE STANDING ANGLE ARTHRODESIS ANGLE RANGES

JOINT
WATSON (°) MILGRAM (°) IN THE LITERATURE (°)*
Hip 119.6
Stifle 138 138.4 125-140
Tarsus 138.5 135.61 130-150
Metatarsal 113.1 110-120
Table 2: Mean value measurements of the normal standing joint angles of the hindlimb in a mixed
population of dogs. Also, recommendations for arthrodesis angles as reported in the literature.
From: Watson et al. VCOT 2003, Milgram et al VCOT 2004.
*Denny HR. Vet Ann 1990, Lesser AS Slatter 2003, Newton CD, Nunamaker 1985, Penwick RC. Vet Clin N Am 1987.
Note 32
Radiographic Measurements of the Femur 34
5 - RADIOGRAPHIC MEASUREMENTS OF THE FEMUR
Radiographic anatomy in the frontal plane
Figure 32 Figure 33
3
1
2
7 6
12 11
10
9
8
13
Figure 32 - Radiograph of the right femur, cranio-caudal projection (frontal plane)
Figure 33 - Radiographic anatomy: 1- head of the femur, 2- neck of the femur, 3- greater tro-
chanter, 4- lesser trochanter, 5- nutrient foramen, 6- medial cortex, 7- lateral cortex, 8- medial
condyle, 9- lateral condyle, 10- trochlear groove of the femur, 11- medial ridge of the trochlea, 12-
lateral ridge of the trochlea, 13- intercondylar fossa.
35 Radiographic Measurements of the Femur
Radiographic anatomy in the sagittal plane
Figure 34 Figure 35
1
3
6
7
10
11
13 8 9
12
Figure 34 - Radiograph of the right femur, medio-lateral projection (sagittal plane)
chanter, 4- lesser trochanter, 5- nutrient foramen, 6- caudal cortex, 7- cranial cortex, 8- profile of
the medial condyle, 9- profile of the lateral condyle, 10- sulcus of the trochlea, 11 - medial ridge
of the trochlea, 12- lateral ridge of the trochlea, 13- intercondylar fossa.
Radiographic anatomy in the transverse plane
Figure 36
2 3
6 5 7
Figure 37
8
9
10
Figure 36 - Radiograph of the right femur, axial projection (transverse plane)
chanter, 4- lesser trochanter, 5- medullary canal, 6- medial cortex, 7- lateral cortex, 8- medial
condyle of the femur, 9- lateral condyle of the femur, 10- intercondylar fossa.
Mechanical and anatomic axes in the frontal plane
A
Figure 38 Figure 39
paa
ma
daa
90°
c
B
Figure 38 - Mechanical axis in the frontal plane

• Use the concentric circles to identify the center of the head of the femur A which constitutes
the center of the proximal joint.
• Identify the center of the distal joint B which is in the intercondylar fossa of the femur, equidi-
stant between the femoral condyles.
• The mechanical axis is the straight line ma connecting the center of the proximal joint A with
the center of the distal joint B.
Figure 39 - Anatomical axis in the frontal plane

The anatomic axis of the femur is represented by a single line, in the center of the medial and
lateral cortices throughout the length of the femur. In the dog, the femoral anatomic axis does
not follow a single straight line, but two straight lines which can be defined as the proximal ana-
tomic axis (paa) and distal anatomic axis (daa). The distal anatomic axis is approximately per-
pendicular to the transverse plane of the distal articular surface of the femur c (the tangent to
the femoral condyles).
Mechanical and anatomic axes in the sagittal plane
A A
Figure 40 Figure 41
ma aa
B B
Figure 40 - Mechanical axis in the sagittal plane

• Use the concentric circles to identify the center of the head of the femur A which constitutes
the center of the proximal joint
• Identify the convex surface on the bony profile of the femoral condyle. When the convexity is divi-
ded into thirds, the midpoint of the central third represents the center of the distal joint B.
• The mechanical axis is defined by a straight line ma connecting the center of the proximal joint
A with the center of the distal joint B.
Figure 41 - Anatomic Axis in the sagittal plane

The anatomic axis of the femur is a single line aa coursing through the cranio-caudal midpoint
of the bone represented by broken lines, from the center of the head of the femur A (the center
of the proximal joint) to the center portion of the distal femoral condyles B (center of the distal
joint). The anatomic axis deviates caudally as it progresses distally resulting from procurvatum
of the femur. This curvature is generally accentuated in small breeds.
Joint orientation lines in the frontal plane
j
B
A
Figure 42 Figure 43
k
I
P P
Figure 42 - Proximal joint orientation line

• Using the concentric circles, identify the center of the head of the femur A.
• Identify the proximal tip of the greater trochanter B.
• The proximal joint orientation line is identified by the line j passing through points A and B.
Figure 43 - Distal joint orientation line

• Identify the most distal convexities of the femoral condyles P and P'.
• The distal joint orientation line is defined by the line k connecting points P and P'.
Proximal and distal anatomic axes of the frontal plane

as defined by Tomlinson (Tomlinson J. et al. 2007)
Figure 44 Figure 45
paa
daa
90°
In the dog, the femoral anatomic axis does not follow a straight line in the frontal plane. Two ana-
tomic axis can be distinguished and characterized as the proximal anatomic axis and distal anato-
mic axis.
Figure 44 - Proximal anatomic axis

• Identify the midpoint between the medial and lateral cortices of the femur at the point halfway
down the length of the femur A.
• Identify the center of the medial and lateral cortices at a point 1/3 down the length of the femur B.
• The proximal anatomic axis is represented by the line paa relative to points A and B.
Figure 45 - Distal anatomic axis

• The distal anatomic axis is represented by a single line daa perpendicular to the joint orienta-
tion line of the distal femur k and in the center equidistant between the cortices of the medial
and lateral condyles of the femur.
Proximal and distal anatomic axes in the sagittal plane

defined by Petazzoni (Petazzoni M, 2008)
paa
Figure 46 Figure 47
A A
E
1/3
F
2/3
C
daa
D
G
2/3 H
1/3
B B
Figure 46 - Proximal anatomic axis

• A reference line is made from the proximal point of the lesser trochanter along the caudal cor-
tex A to the proximal limit of the trochlea of the femur along the cranial cortex B. This line AB
is divided into quarters and point C placed 1/4 of the length of AB (from proximal to distal). The
AC is then divided into thirds. The cranio-caudal midpoint between the cortices is determined
at 1/3 and 2/3 the length of AC and marked as points E and F, respectively. The proximal ana-
tomic axis paa is a straight line passing through points E and F.
Figure 47 - Distal anatomic axis

• Use the previously described reference line AB.
• Divide the length of line AB into quarters with point D representing 3/4 of the length of AB.
• The cranio-caudal midpoint of the femur between the cortices is determined at 1/3 and 2/3 the
length of line BD and are marked points G and H, respectively.
• The distal anatomic axis, daa is a straight line passing through points G and H.
Nomenclature of the joint angles in the frontal plane

as defined by Paley (Paley D. 2003)
Proximal joint
Figure 48 orientation line Figure 49
aLPFA mLPFA
aMPFA mMPFA
Anatomic Axis (aa) Mechanical Axis (ma)
aLDFA aMDFA mLDFA mMDFA
Distal joint
orientation line
Figure 48 - Nomenclature proposed by Paley D., for the joint angles of the femur based on the
anatomic axis.
aLPFA - anatomic Latero-Proximal Femoral Angle; aLDFA - anatomic Latero-Distal Femoral
Angle; aMPFA - anatomic Medio-Proximal Femoral Angle; aMDFA - anatomic Medio-Distal
Femoral Angle (Paley D. 2003).
Figure 49 - Nomenclature proposed by Paley D., for the joint angles of the femur based on the
mechanical axis.
mLPFA - mechanical Latero-Proximal Femoral Angle; mLDFA - mechanical Latero-Distal
Femoral Angle; mMPFA - mechanical Medio-Proximal Femoral Angle; mMDFA- mechanical
Medio-Distal Femoral Angle (Paley D. 2003).
Mean values of the joint angles of the femur in the frontal plane
reported in the literature
AUTHOR SUBJECTS METHOD aLDFA (°) aLPFA (°) mLDFA (°) mLPFA (°)
Cranio-caudal
99.4 ± 2.3 - - -
Radiographs
Radiographs 99.2 ± 3.3 - - -

Dudley 18 femurs
et al. 2006 20-30 Kg Computerized
98.8 ± 3.3 - - -
Tomography
Anatomic
97.4 ± 3.9 - - -
Preparation
Radiographs 95.8 ± 1.0 - - -

Swiderski
10 femurs
et al. 2008 Anatomic
95.2 ± 2.1 - - -
Specimen
100 Golden
97 ± 2.8 98 ± 5.7 100 ± 2.3 95 ± 5.2
Retriever femurs
100 Labrador
97 ± 3.2 103 ± 6.4 100 ± 2.6 100 ± 6.0
Retriever femurs
Tomlinson
Radiographs
et al. 2007 100 German
94 ± 3.3 101 ± 5.0 97 ± 3.1 97 ± 4.5
Shepherd femurs
100 Rottweiler
98 ± 3.5 96 ± 5.3 100 ± 2.7 93 ± 4.7
femurs
Dismukes Cadaveric
101 Femurs - - 98.6 ± 2.5 103.7 ± 5.4
et al. 2008 radiographs
Table 3 - Anatomic Latero-Distal Femoral Angles greater than 90 degrees indicate varus of the
distal femur while angles smaller than 90 degrees indicate valgus of the distal femur. The normal
femur as reported in the table, has a small degree of distal varus noted by the aLDFA between 94
and 99 degrees.
Joint angles with respect to the anatomic axis in the sagittal plane
as proposed by the authors using nomenclature of Paley (Paley D. 2003)
paa
A
Figure 50 Figure 51
B A
aCd
aCdPFA
ca daa
90° aCdDFA
B
x
Figure 50 - anatomic Caudo-Proximal Femoral Angle - aCdPFA

• Use the concentric circles to identify the center of the head of the femur, A.
• The center of the femoral neck, B is identified by the cranio-caudal midpoint of the narrowest por-
tion of the neck.
• The axis of the femoral neck is represented by line ca which passes through points A and B.
• The anatomic Caudo-Proximal Femoral Angle, aCdPFA is the angle between the axis of the neck
of the femur ca and the proximal anatomic axis paa ( see page 41).
Figure 51 - anatomic Caudo-Distal Femoral Angle- aCdDFA

• To determine the axis of the distal femur, a straight reference line AB is created between the
proximal point of the lesser trochanter along the caudal cortex, point A and the proximal extent
of the trochlea along the cranial aspect of the femur, point B.
• Draw line x through point B perpendicular to the reference line AB.
• anatomic Caudo-Distal Femoral Angle, aCdDFA is defined by the angle formed between the axis
of the distal femur x and the distal anatomic axis of the femur daa (see page 41).
Joint angles with respect to the mechanical axis in the sagittal plane as
proposed by the authors using nomenclature of Paley (Paley D. 2003)
Figure 52 A Figure 53
B A
ca
mCdPFA ma
ma
90°
x mCdDFA
B
Figure 52 - mechanical Caudo-Proximal Femoral Angle - mCdPFA

• Use the concentric circles to identify the center of the head of the femur, point A.
• The center of the femoral neck, point B is identified by the cranio-caudal midpoint of the narrowest
portion of the neck.
• The axis of the femoral neck is represented by line ca which connects through points A and B
• The mechanical Caudo-Proximal Femoral Angle, mCdPFA is the angle between the axis of the
neck of the femur ca and the mechanical axis ma.
Figure 53 - mechanical Caudo-Distal Femoral Angle - mCdDFA

• To determine the axis of the distal femur, a straight reference line AB is created between the
proximal point of the lesser trochanter along the caudal cortex, point A and the proximal extent
of the trochlea along the cranial aspect of the femur, point B.
• Draw line x through point B perpendicular to the reference line AB.
• The mechanical Caudo-Distal Femoral Angle mCdDFA is defined by the angle formed between
the axis of the distal femur x and the mechanical axis of the femur ma.
Femoral neck angle or angle of inclination as described

by Tomlinson (Tomlinson et al. 2007)
A
B
paa
ca ca
C
paa
Figure 54 - Axis of the femoral neck

• Using the concentric circles, identify the center of the head of the femur, A.
• Identify the midpoint of the femoral neck at its narrowest point, B.
• The axis of the femoral neck is represented by a straight line ca, passing through points A and B.
Figure 55 - Anatomic axis of the proximal femur

• Identify point C, the midpoint of the medio-lateral cortices halfway down the length of the femur.
• Identify point D, the midpoint of the medio-lateral cortices 1/3 down the length of the femur.
• The proximal anatomic axis is represented by a straight line paa passing through points C and D.
Figure 56 - Femoral neck angle or angle of inclination

• The axis of the femoral neck or the angle of inclination is the angle formed between the proximal
anatomic axis paa and the axis of the femoral neck, ca.
Table 4
Femoral neck angle (°)
Golden Retriever 134±5.2
Labrador Retriever 134±5.3
German Shepherd 132±5.9
Rottweiler 137±5.4 (Tomlinson et al. 2007)

by Hauptman, method A (Hauptman et al. 1979)
ca ca
A
k
B D C
paa paa paa
Figure 57 - Proximal anatomic axis of the femur

• The proximal anatomic axis of the femur is represented by a single straight line paa centered
between the medial and lateral cortices along the length of the proximal femur.
Figure 58 - Cervical axis

• A single point A is placed at the midpoint of the the head of the femur at its greatest width (at
the level of the physis/physeal scar).
• Point B is placed at the distal point of the fossa of the greater trochanter.
• Reference line k is drawn perpendicular to the proximal anatomic axis of the femur at the level
of point B. Point C is located along the medial cortex of the femur intersected by line k.
• Point D is marked along line k at the midpoint between points B and C.
• The axis of the neck of the femur ca is represented by a straight line passing through points A and D.
Figure 59 - The femoral neck angle or the angle of inclination

• The angle formed between the proximal anatomic axis paa and the cervical axis ac. The normal
value for the angle of inclination in the dog is 146 degrees +/- 4.8 (Hauptman et al. 1979)

by Hauptman, method B (Hauptman et al. 1985)
ac ac
A
paa paa
Figure 60 - Proximal anatomic axis of the femur

• The proximal anatomic axis of the femur is represented by a single straight line paa centered
between the medial and lateral cortices along the length of the proximal femur.
Figure 61 - Cervical Axis

• A single point A is placed in the midpoint of the head of the femur at a location corresponding
to the greatest width of the head of the femur
• Point B is placed at the midpoint where the femoral neck is at its narrowest width.
• The axis of the femoral neck ca is represented by a straight line passing through points A and B.

• The angle formed between the proximal anatomic axis paa and the cervical axis ca. The normal
value for the angle of inclination in the dog is 129 degrees +/- 4.9 (Hauptman et al. 1985).
Table 5
Femoral neck angle (°)
German Shepherd 125.7±0.5
Greyhound 128.7±0.7
Italian Greyhound
128.6±0.9
German Shepherd (Hauptman et al. 1985)
Femoral neck angle or the angle of inclination

(Schawalder 1981, Bardet 1983, Montavon 1985)
ca ca
paa paa
A
B
C
D
PI PI
20 mm
P P
20 mm
PII PII
Figure 63 - The anatomic axis of the proximal femur

• A point P is placed at the midpoint between the medial and lateral cortices where the diaphy-
sis of the femur is narrowest.
• Point P' is placed at the midpoint between the medial and lateral cortices 20mm proximal to
point P.
• Point P" is placed at the midpoint between the medial and lateral cortices 20mm distal to point P.
• The anatomic axis of the proximal femur paa is a straight line passing through point P' and P".
Figure 64 - Cervical axis

• Using the concentric circles, identify the center of the head of the femur, point A.
• Identify the distal point of the fossa of the greater trochanter point B.
• Draw a circle centered over point A with a radius equal to the distance between point A and B.
The point where the circle intersects the medial cortex of the femur is point C.
• Draw a circle centered over point B with a radius equal to the distance between points B and C.
Where the circle intersects with the lateral cortex of the femur is point D.
• The cervical axis ca is a straight line passing through points A and D.

• The angle formed between the proximal anatomic axis paa and the cervical axis ca. The normal
value for the angle of inclination is between 137° and 155° degrees with a median value of
144.7° degrees. The normal angle value in the German Shepherd is 147.5° +/- 4.5 degrees
(Schawalder 1980).
Femoral neck angle or the angle of inclination and Anatomic axis;

the SYMAX method (SYMmetric AXis-based method)
ca
A
Figure 66 Figure 67 B
aa
The SYMAX method applies geometry to biology in order to simplify measurements on complex amor-
phous structures. This technique uses various sized circles corresponding to the outline of the struc-
ture. (Figures 66 and 67).
• Draw a circle centered over the femoral head so that it matches the outline of the bone in at least
3 points. The center of the circle is point A.
• Draw a circle in the proximal metaphysis of the femur so that it matches the outline of the femur
in at least 3 points. The center of the circle is point B.
• Draw a circle in the distal metaphysis of the femur so that it matches the outline of the femur in at
least 3 points. The center of the circle is point C.
Figure 67 - The anatomic axis of the femur

• Is represented by the straight line aa passing though points B and C.
The cervical axis

• Is represented by a straight line ca passing through points A and B.
The femoral neck angle or the angle of inclination

• Is the angle formed between the anatomic axis of the femur aa and the cervical axis ca.
Values of the the femoral neck angle or angle of inclination reported

in the literature using the SYMAX method
Table 6
Number of Number of Mean femoral neck angle (°)
Breeds
Subjects femurs evaluated +/- standard deviation
Anatolian Shepherd 10 20 138.60 ± 1.29
Dobermann 20 40 127.04 ± 1.07
Golden Retriever 10 20 129.25 ± 2.75
Labrador Retriever 42 84 131.61 ± 0.76
German Shepherd Dog 88 166 129.9 ± 0.46
Pointer 26 52 129.84 ± 0.98
Irish Setter 12 24 128.91 ± 1.51
(Sarierler 2004)
Measurement of femoral torsion and angle of anteversion

of the femoral neck (Nunamaker D.M. et al. 1973).
A
B
ca
α
z Figure 68
The orientation angle of the femoral neck in the transverse plane in relation to the femoral con-
dyles is defined as the angle of femoral version or the angle of anteversion. Version of the femo-
ral neck and femoral torsion are commonly considered synonymous.
This angle can be measured using the axial radiographic projection of the femur corresponding to
the transverse plane of the bone.
Cervical Axis
• Using concentric circles, identify the center of the head of the femur A.
• Identify the center of the neck of the femur B at the midpoint between the cranial and caudal cor-
tices of the femoral neck.
• The cervical axis is represented by a line ca passing through the center of the femoral head at
point A and the center of the femoral neck at point B.
Angle of anteversion
• The angle of anteversion α is formed by the intersection of the cervical axis ca and the line z that
is tangent to the distal articular surface of the femoral condyles .
Table 7
Number of subjects Evaluation Method Angle of Femoral Torsion (°)

Axial radiograph 16 ± 6.4
Mixed breed dogs
Computed tomography 19.6 ± 7.9
(29 - 39 Kg)
Anatomic specimen 18.9 ± 5.4
(Dudley 2006)
Measurement of the femoral torsion angle or angle of anteversion

of the femoral neck with the biplanar or trigonometric
method (Schawalder 1981, Bardet 1983, Montavon 1985)
paa paa
y Ax
Figure 69 A Figure 70
PI PI
20 mm
P P
20 mm
PII PII
To calculate the torsion angle or angle of anteversion of the femoral neck with the biplanar
method, it is necessary to measure the distance from the center of the femoral head to the ana-
tomic axis of the femur in the frontal plane y and in the sagittal plane, x.
Figure 69 - Segment y, frontal plane

• Using concentric circles identify the center of the head of the femur, A.
• Identify the proximal anatomic axis of the femur paa as described by Schawalder (see page 49)
• The segment y corresponds to the shortest distance between the center of the femoral head A
and the anatomic axis of the proximal femur paa.
Figure 70 - Segment x, sagittal plane

• Using concentric circles, identify the center of the head of the femur A.
• Identify the anatomic axis of the proximal femur paa in the same manner as previously prescri-
bed for the frontal plane (see above).
• The segment x corresponds to the shortest distance between the center of the femoral head, A
and the anatomic axis of the proximal femur paa.
The projection of segments x and y on the transverse plane

create a triangle where x and y are two adjacent sides and
the resultant hypotenuse represents the axis of the femo-
ral neck AC. The angle α represents the angle of antever-
sion of the femoral neck and can be calculated with the
equation:
tan α = xy
A
Axis of the femoral
neck
x
C
y
y
Figure 71
A
x
C
30
25 5° 15°
25°
10° 20° 35°
20
30° 45°
40° 55°
y (mm)
15 50°
60° 65°
10
70° 75°
5
Graphical identification of the

80°
angle of anteversion of the
85°
femoral neck is determined by 0
0 5 10 15 20 25 30
the length of segments x and y x (mm)
in mm.
Estimation of femoral torsion comparing the proximal and distal

aspect of the bone
A standard ventro-dorsal radiographic projection of the pelvis or cranio-caudal view of the femur
can be used to estimate the presence and severity of femoral torsion. It is critical that the femur
be parallel to the x-ray table and the proximal aspect of the femur in a straight cranio-caudal posi-
tion, perpendicular to the x-ray beam. The lesser trochanter should be visible as seen as in the
examples below. Torsion of the femur is assessed by comparing the distal aspect of the femur with
the proximal aspect. The examples (Fig 72 and Fig 73) demonstrate the proximal femur in perfect
cranio-caudal alignment with the distal femur rotated in 5 degree increments, externally and
internally. Note the increasing degree of asymmetry between the condyles corresponding to the
increasing degree of rotation. The direction of rotation can be determined by the size discrepancy
of the condyles. In external torsion, the lateral condyle is smaller whereas in internal torsion, the
medial condyle is smaller. Also, with increased torsion, there appears to be a caudal bowing of the
distal aspect of the femur which is a positional radiographic change, not to be mistaken with an
angular deformity. The direction of the torsion is referred from proximal to distal and is termed on
the position of the distal portion of the limb.
Traditionally, assessment of torsion has been made by evaluation of the fabellae and patella in
relation to the femur. Because these structures are not part of the femur and can vary in relation
to the pathologic femur, we have elected to show the femur devoid of these structures for true
assessment of the femur and femoral torsion.
Internal External
0 5 10 15 0 5 10 15
20 25 30 35 20 25 30 35
Figure 72
Above, radiograph of the proximal portion of the left
femur, cranio-caudal projection.
Below, a series of radiographs of the distal portion of

the femur starting at 0° (cranio-caudal) and increasing
internal torsion in 5° increments to a maximum torsion
of 35°. Notice after 15° torsion the radiographic appea-
rance of the trochlear ridges are no long apparent.
0° 5° 10°
15° 20° 25°
30° 35°
Figure 73
Above, radiograph of the proximal portion of the left
femur, cranio-caudal projection.
Below, a series of radiographs of the distal portion of

the femur starting at 0° (cranio-caudal) and increasing
external torsion in 5° increments to a maximum torsion
of 35°. Notice after 15° torsion the radiographic appea-
rance of the trochlear ridges are no longer apparent.
0° 5° 10°
15° 20° 25°
30° 35°
Note 58
Radiographic Measurements of the Tibia 60
6 - RADIOGRAPHIC MEASUREMENTS OF THE TIBIA
Radiographic anatomy in the frontal plane

Figure 74 Figure 75
5 4 3
6 2
8 7
T 2
11 3
10
Figure 74 - The right tibia and fibula, caudo-cranial projection (frontal plane)
Figure 75 - Radiographic anatomy: T- tibia, 1- tibial crest, 2- lateral condyle, 3- lateral intercondylar
eminence, 4- intercondylar area, 5- medial intercondylar eminence, 6- medial condyle, 7- lateral cor-
tex, 8- medial cortex, 9- caudal border of the cochlea of the tibia, 10- cranial border of the cochlea of
the tibia, 11- medial malleolus, F- fibula, 1- head of the fibula, 2- body of the fibula, 3- lateral mal-
leolus
61 Radiographic Measurements of the Tibia
Radiographic anatomy in the sagittal plane
Figure 76 Figure 77
2
3
5
1
6 1
7 2 8
9
10
3
Figure 76 - The right tibia and fibula, medio-lateral projection (sagittal plane)
Figure 77 - Radiographic anatomy: T-tibia, 1- tibial crest, 2- medial intercondylar eminence, 3- late-
ral intercondylar eminence, 4- medial condyle, 5- lateral condyle, 6- popliteal sulcus, 7- cranial cor-
tex of the tibia, 8- caudal cortex of the tibia, 9- medial malleolus, 10- cochlea of the tibia, F- fibula
1- head of the fibula, 2- body of the fibula, 3- lateral malleolus
Mechanical and anatomic axes in the frontal plane
A A
Figure 78 Figure 79
ma aa
B B
Figure 78 - Mechanical axis in the frontal plane

• The center of the proximal articular surface A is in the intercondylar area at the midpoint betwe-
en the two intercondylar tuberosities.
• The center of the distal articular surface B is along the convexity of the caudal border of the cochlea
of the tibia at the midpoint between the medial and lateral malleoli.
• The mechanical axis, ma, is a straight line connecting the center of the proximal articular surface
A with the center of the distal articular surface B.
Figure 79 - Anatomic axis in the frontal plane using the SYMAX method
• The anatomic axis, aa is represented by a single contoured line centered between the medial and
lateral cortices throughout the length of the tibia connecting the center of the proximal articular
surface A to the center of the distal articular surface B. In the dog, the anatomic axis of the tibia
does not follow closely to the straight line of the mechanical axis.
Mechanical and anatomic axes in the sagittal plane
A A
Figure 80 Figure 81
ma aa
B Center of the trochlea B
Figure 80 - The mechanical axis in the sagittal plane

• The center of the proximal articular surface A is centered between the cranial and caudal bor-
ders of the tibial plateau (green arrows).
• The center of the distal articular surface B, is in the center of the cochlea (or trochlea of the
talus) and can be identified with the concentric circles.
• The mechanical axis ma is represented by a straight line connecting the center of the proximal
articular surface A with the center of the distal articular surface B.
Figure 81 - The anatomic axis in the sagittal plane using the SYMAX method
• The anatomic axis is represented by a single contoured line aa centered between the cranial and
caudal cortices connecting the center of the proximal articular surface A to the center of the distal
articular surface B. There is a cranial curve or procurvatum in the proximal third of the tibia.
Joint orientation lines in the frontal plane
j
Figure 82 Figure 83
Figure 82 - The proximal joint orientation line

• The joint orientation line of the proximal tibia j, in the frontal plane, is represented by a line pas-
sing through the distal points of the concavities of the medial and lateral tibial condyles.
Figure 83 - The distal joint orientation line

• The joint orientation line of the distal tibia k in the frontal plane, is represented by a straight line
passing through the proximal points of the medial and lateral concavities of the tibial cochlea.
Joint orientation lines in the sagittal plane
Figure 84 Figure 85
Figure 84 - The proximal joint orientation line

• The joint orientation line of the proximal tibia, j, in the sagittal plane is represented by a line
passing through the cranial and caudal extents of the tibial plateau.
Figure 85 - The distal joint orientation line

• The joint orientation line of the distal tibia, k, in the sagittal plane is represented by a line con-
necting the distal most aspect of the cranial and caudal cortices of the tibia.
Nomenclature of the joint angles in the frontal and sagittal planes

as described by Paley (Paley D. 2003)
Figure 86 Figure 87
mCrPTA
mMPTA mLPTA
mCdPTA
mMDTA mLDTA mCrDTA mCdDTA
Figure 86 and 87 - Nomenclature of yhe joint angles in the frontal and sagittal planes
The proximal and distal joint angles of the tibia in the frontal and sagittal planes consist of the
intersection of the proximal and distal joint orientation lines with the mechanical axis.
mMPTA - mechanical Medio-Proximal Tibial Angle, mMDTA - mechanical Medio-Distal Tibial
Angle, mCdPTA - mechanical Caudo-Proximal Tibial Angle, mCdDTA - mechanical Caudo-Distal
Tibial Angle.
The respective supplementary angles are referred as: mLPTA - mechanical Latero-Proximal Tibial
Angle, mLDTA- mechanical Lateral-Distal Tibial Angle, mCrPTA - mechanical Cranio-Proximal
Tibial Angle, mCrDTA - mechanical Cranio-Distal Tibial Angle
Tibial Plateau Angle and mechanical Caudal Proximal Tibial Angle

(mCaPTA)
a ma
TPA
Figure 88 c
90°
mCaPTA
Center of the trochlea
Figure 88 - The Tibial Plateau Angle (TPA) and mCaPTA

• Draw the proximal joint orientation line a as previously described (Figure 84)
• Draw the mechanical axis ma as previously described (Figure 80)
• Draw a line c perpendicular to the mechanical axis ma at the level of the intersection of the joint
orientation line a and the mechanical axis ma.
• The tibial plateau angle TPA is the acute angle formed by the proximal joint orientation line a and a
line perpendicular to the mechanical axis, c.
The mechanical Caudal Proximal Tibial Angle (mCaPTA) is the caudo-distal angle formed by the pro-
ximal joint orientation line and the mechanical axis.
Mean values of the joint angles in the frontal plane

Table 8
Author Number of Joints Angle Cruciate Ligament Mean Value (°)
Tomlinson 2006 - Intact ligament 93
Dismukes
105 Ruptured CCL 93.30 ± 1.78
et al. 2007
mMPTA
Dismukes Labrador Retrievers with
70 93.38 ± 1.81
et al. 2007 ruptured CCL
Dismukes
105 Ruptured CCL 92.2 ± 1.8
et al 2008
Tomlinson 2006 - Intact CCL 96
Dismukes
105 Ruptured CCL 95.99 ± 2.70
et al. 2007
mMDTA
Dismukes Labrador Retrievers with
70 96.34 ± 2.51
et al. 2007 ruptured CCL
Dismukes et al 2008 105 Ruptured CCL 95.9 ± 2.2
Mean values of the joint angles in the sagittal plane

Table 9
Author Joints Angle Breeds Cruciate Ligament Mean Value (°)
Morris E, Lipowitz AJ, 2001 62 - 18.1
36 Greyhounds 22.5
Wilke VL et al 2002 Intact ligaments
80 Labrador Retrievers 27.97 ± 0.66
23.6 ± 3.5
Reif U., Probst CW. 2003 78 Labrador Retrievers
(15- 29 range)
Morris E, Lipowitz AJ, 2001 112 - 23.8
Wilke VL et al 2002 88 Labrador Retrievers 25.55 ± 0.55

26.2 ± 0.3
Pacchiana et al 2003 397 -
(12 - 42 range)
26.2 ± 4°
Priddy II NH et al. 2003 253 TPA** (17 - 46 range)
23.5 ± 3.1
Reif U., Probst CW. 2003 84 Labrador Retrievers
(18 - 30 range)
22*
Vezzoni A. et al. 2003 293 -
Ruptured (16 - 40 range )
cruciate ligament 27.4
Petazzoni M. 2006 36 Small dogs
(21-34 range)
26
Stauffer et al. 2006 696 -
(16 - 36 range)
Dismukes et al 2008 104 Labrador Retrievers 26.2
Medium
Dismukes et al 2008 46 27
and large dogs
Dismukes et al 2008 104 Labrador Retrievers 81.7 ± 4.2
mCrDTA Medium
Dismukes et al 2008 46 81.5 ± 4.1
and large dogs
* Median value ** TPA= 90°-mCaPTA

Estimation of tibia torsion comparing the proximal and distal

aspect of the bone
A cranio-caudal view of the tibia is used to estimate the presence and degree of tibial torsion. It
is critical that the tibia be parallel to the x-ray table and the longitudinal axis of the tibia in a
straight cranio-caudal position perpendicular to the x-ray beam.
Torsion of the tibia is assessed by comparing the proximal aspect of the tibia with the distal
aspect. The distal tibia is in a straight cranio-caudal position when the medial cortex of the cal-
caneus transects middle the cochlea. The examples (Figure 89 and 90) demonstrate the distal
tibia is perfect caudocranial alignment with the proximal tibia torsion in 5 degree increments,
externally and internally. The direction of the torsion is referred from proximal to distal and is ter-
med on the position of the distal portion of the limb.
0 5 10 15 0 5 10 15
20 25 30 35 20 25 30 35
Internal External
0° 5° 10°
15° 20° 25°
30° 35°
Figure 89
Above - a series of caudo-cranial projection radiographs
of the proximal tibia in 5°increments of internal torsion
from 0° (caudo-cranial) to 35°. Notice the change in the
appearance of the tibial tuberosity. At 20° the tibial tube-
rosity is at the level of the lateral cortex. Greater than 20°
torsion, the tibial tuberosity can be seen protruding
beyond the cortex.
Below - a caudo-cranial projection radiograph of the distal

tibia showing the medial cortex of the calcaneus transec-
ting the cochlea of the tibia.
0° 5° 10°
15° 20° 25°
30° 35°
Figure 90
Above - a series of caudo-cranial projection radiographs of
the proximal tibia in 5° increments of external torsion from
0° (caudo-cranial) to 35°. Notice the change in the appea-
rance of the tibial tuberosity. At 20° the tibial tuberosity is
at the level of the medial cortex. Greater than 20° torsion,
the tibial tuberosity can be seen protruding beyond the
cortex.
Below - a caudo-cranial projection radiograph of the distal

tibia showing the medial cortex of the calcaneus transec-
ting the cochlea of the tibia.
Note 72
Radiographic Measurements of the Hips 74
7 - RADIOGRAPHIC MEASUREMENTS OF THE HIP
Standard Ventro-dorsal projection (OFA- FCI)
1 2
5 4 B
7
3 6 1
9
4 2 8
F 12
10
5
11
7
6
L R
M
12 11
10
9 8
13
The Dorsal Acetabular Rim (DAR)
1 7
2
3
The ventro-dorsal distraction projection
3 2
3
1
5
2 7
4
4
5
9
F 8
B
75 Radiographic Measurements of the Hips
Radiographic anatomy. Standard ventro-dorsal projection (OFA - FCI)
Figure 91
Figure 91 - Radiograph of the coxofemoral joints, standard ventro-dorsal projection

1 2
Figure 92
5 4 B
7
3 6 1
9
4 2 8
F 12
10
5
11
7
6
L R
M
12 11
10
9 8
13
Figure 92 - Radiographic anatomy: B–pelvis, 1- wing of the ilium, 2- iliac tuberosity, 3- body of the
ilium, 4- cranial border of the acetabulum, 5- cranio-dorsal border of the acetabulum, 6- dorsal
border of the acetabulum, 7- ventral border of the acetabulum, 8- fossa of the acetabulum, 9-
pubis, 10- body of the ischium, 11- ischiatic tuberosity, 12- obturator foramen; F-femur, 1. head
of the femur, 2. neck of the femur, 3. greater trochanter, 4. trochanteric fossa, 5. lesser trochan-
ter, 6. medial cortex, 7. lateral cortex, 8. medial condyle, 9. lateral condyle, 10. femoral trochlea,
11. medial ridge of the trochlea, 12. lateral ridge of the trochlea, 13. intercondylar sulcus, R- patel-
la, L- lateral fabella, M- medial fabella
Norberg Angle
Figure 93
A A
1. Using concentric circles, identify the centers of the heads of the femurs A.
Figure 94
A A r
2. Draw a straight line r passing through the centers of the heads of the femurs A.
Figure 95
B B
A A r
3. Identify the cranio-dorsal border of the acetabulum B.

Figure 96
s s
B B
A A r
4. For each joint, draw a straight line s connecting points A and B.
Figure 97
s s
B B
A A r
5. The Norberg Angle is the internal angle defined by the intersection of lines s and r. The nor-
mal value of the Norberg Angle is >105° (Douglas 1970)
Radiographic anatomy. The Dorsal Acetabular Rim projection (DAR)

Figure 98
Figure 99
1 7
2
3
Figure 98 - Radiograph of the coxofemoral joints, DAR view.
Figure 99 - Radiographic anatomy: 1- Dorsal Acetabular Rim (DAR), 2- femoral head, 3- greater
trochanter, 4- trochanteric fossa, 5- lesser trochanter, 6- wing of the ilium, 7- sacrum.
Measurement of the DAR angle (Dorsal Acetabular Rim) or angle

of inclination of the dorsal acetabular rim
The angle of inclination of the dorsal acetabular rim is determined by the intersection of
a line perpendicular to the sagittal plane at the level of the center of the femoral heads
and the tangent to the dorsal acetabular rim at the most lateral point of contact betwe-
en the head of the femur and the dorsal acetabular rim. In normal patients, this angle is
< 7.5 ° (Slocum and Devine 1990)
Figure 100
1. Identify the center of the acetabulum A, using the concentric circles.
Figure 101
B
A
2. Identify the point B, the most lateral point of subchondral contact between the the dorsal aceta-
bular rim and the femoral head. The line AB represents the radius of the described acetabulum.
Figure 102
90° B
A
3. Draw a straight line t, tangent to the dorsal acetabular rim, and perpedicular to the line AB.
Figure 103
a
t
B
z A V
4. Draw line a along the sagittal plane through the center of the pelvis.
5. Identify point V at the intersection of lines t and a.
6. Draw the line z at the level of V perpendicular to line a.
Figure 104
a
t
B
α
z A V
7. The DAR angle or the angle is defined by the intersection of the line t tangent to the dorsal ace-
tabular rim and line z.
Figura 105
a
t
α B tI
I BI β
V
I
z A V AI z
In the example above,the right DAR β is 4° (within normal limits). The left DAR α is 17° (abnormal).
Radiographic anatomy. Ventro-dorsal projection with distraction
Figure 106
Figure 107
3 2
3
1
5
2 7
4
4
5
9
F 8
Figure 106 - Radiograph of the coxofemoral joints, ventro-dorsal projection with distraction
Figure 107 - Radiographic anatomy: B–pelvis, 1- body of the ilium, 2- cranial surface of the ace-
tabulum, 3- cranio-dorsal border of the acetabulum, 4- dorsal rim of the acetabulum, 5- ventral
border of the acetabulum, 6- fossa of the acetabulum, 7- pubis, 8- ischium, 9- obturator foramen,
F- femur, 1- femoral head, 2- femoral neck, 3- physis, 4- greater trochanter, 5- trochanteric fossa.
Measurements to calculate the distraction index (DI)

Figure 108
1. Identify the center of the acetabulum A, using concentric circles.
Figure 109
r
B
2. Identify the center of the femoral head, B, using concentric circles.

3. Measure the radius, r, of the head of the femur.
Figure 110
r
B A
4. The DI (distraction index) is obtained by dividing the length of segment AB over the radius r of
the femoral head.
AB
DI = r
The distraction index describes the amount of distraction of the femoral head (or lack of coverage by the
acetabulum) relative to the radius of the femoral head and is a measure of the degree of joint laxity.
The calculated index value is expressed as a number between 0 and 1.
A Index value of 0 indicates a perfectly congruent coxofemoral joint with no laxity and the position of the
center of the femoral head A coincides with the center of the acetabulum B.
Conversely, an index value of 1 is indicative of complete lack of coverage of the femoral head by the ace-
tabulum. In this case, the distance between the center of the femoral head A, to the center of the ace-
tabulum B is equal to the radius of the femoral head and severe joint laxity.
An intermediate distraction index value of 0.6 indicates that the femoral head is subluxated 60% from
the acetabulum relative to the radius of the femoral head or alternatively, there is only 40% coverage of
the femoral head by the acetabulum.
The value of the distraction index correlates to the probability of developing changes within the joint, par-
ticularly osteoarthritis. For example, a smaller distraction index value correlates to a small probability
of a dog developing osteoarthritis in the future compared to a higher index value.
There are some breed variations relative to the normal amount of laxity in the coxofemoral joints (Figure
106). In Labrador Retrievers, at 4 months of age, a Distraction Index value of >0.7 is associated with a
high probability of developing of hip dysplasia. Conversely, a index value < 0.4 is associated with a low
probability of developing hip dysplasia and will have a healthy normal joint. The intermediate value bet-
ween 0.4 and 0.7 has been associated with development of hip dysplasia in 57% of the animals.
Distraction Index of the adult dog is 0.29 (Lust G. et al. 1993)
Figure 111
1.0
German Shepherds (n=3729)
0.9
Golden Retriever (n=4545)
Probability of developing arthritis
0.8 Labrador Retriever (n=6278)

Rottweiler (n=1191)
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 1.1
Distraction Index
Figure 111 - Graphical depiction of the probability of developing osteoarthritis relative to the
distraction index value amongst various breeds of dogs. The data refers to dogs at 24 months of age
and includes data for the German Shepherd, Golden Retriever, Labrador Retreiver and Rottweiler
breeds. The left shift of the German Shepherds relative to the other breeds indicates a higher pro-
bability of developing hip dysplasia with a given Distraction Index value.
(Smith GK, et Al.: Evaluation of risk factors for degenerative joint disease associated with hip dysplasia in German
Shepherd dogs, Golden Retrievers, Labrador Retrievers and Rottweilers. J Am Vet Med Assoc. 2001; 219:1719–1724.). This
image was reproduced with the authorization of the editor.
Note 86
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Norberg Angle
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Note 93
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Introduction by the Author

Introduction by the Co-Author

My first experience with angular limb deformities and orthopedics in gene-

Introduction by the Editor

On face value, it could be considered an anachronism to add clinical goniome-

3 – Terminology and Definitions 18

5 - Radiographic Measurements of the Femur 34

6 - Radiographic Measurements of the Tibia 60

7 - Radiographic Measurements of the Hip 74

2 - THE GONIOMETER WITH ARMS

1 Millimeter ruler (0-350mm)

The measurement of angles

The use of concentric circles - the Mose method

3 - TERMINOLOGY AND DEFINITIONS

• The sagittal plane

• The frontal plane

• The transverse plane

Bone Angular Deformities

Figure 13 Figure 14 Figure 15

• Varus Deformity of the Bone

• Valgus Deformity of the Bone

• Procurvatum Deformity of the Bone

• Recurvatum Deformity of the Bone

• Torsional Deformity of the Bone

Joint Angular Deformities

• Varus Deformity of the Joint

• Procurvatum Deformity of the Joint

• Recurvatum Deformity of the Joint

• Rotational Deformity of the Joint

Figure 16 - Measurement of the Angle of Figure 17 - Measurement of the Angle of

Figure 18 - The measurement of the maximum Angle of

Angle of maximum Flexion Angle of maximum Extension

POSITIONING OF THE GONIOMETER

Angle of maximum Flexion Angle of maximum Extension

POSITIONING OF THE GONIOMETER

Angle of maximum Flexion Angle of maximum Extension

POSITIONING OF THE GONIOMETER

Angle of maximum Flexion Angle of maximum Extension

POSITIONING OF THE GONIOMETER

Angle of maximum Flexion Angle of maximum Extension

POSTIONING OF THE GONIOMETER

Angle of maximum Flexion Angle of maximum Extension

POSITIONING OF THE GONIOMETER

Normal standing joint angles of the hindlimb

STANDING ANGLE STANDING ANGLE ARTHRODESIS ANGLE RANGES

Stifle 138 138.4 125-140

Tarsus 138.5 135.61 130-150

Metatarsal 113.1 110-120

5 - RADIOGRAPHIC MEASUREMENTS OF THE FEMUR

Radiographic anatomy in the frontal plane

Figure 32 - Radiograph of the right femur, cranio-caudal projection (frontal plane)

Radiographic anatomy in the sagittal plane

Figure 34 - Radiograph of the right femur, medio-lateral projection (sagittal plane)

Radiographic anatomy in the transverse plane

Figure 36 - Radiograph of the right femur, axial projection (transverse plane)

Mechanical and anatomic axes in the frontal plane

Figure 38 - Mechanical axis in the frontal plane

Figure 39 - Anatomical axis in the frontal plane

Mechanical and anatomic axes in the sagittal plane

Figure 40 - Mechanical axis in the sagittal plane

Figure 41 - Anatomic Axis in the sagittal plane