Original Research 445

Comparison of Early Measurements of the Distraction

Index, Norberg Angle on Distracted View and the
Official Radiographic Evaluation of the Hips of
215 Dogs from Two Guide Dog Training Schools
Mathieu Taroni1,2 Jean-Pierre Genevois1,2 Eric Viguier1,2 Paul Pillard1,2 Véronique Livet1,2
Thibaut Cachon1,2 Claude Carozzo1,2

1 Department of Small Animal Surgery, Campus Vétérinaire de Lyon, Address for correspondence Jean-Pierre Genevois, DVM, PhD,
Marcy L’Etoile, France Department of Small Animal Surgery, Campus Vétérinaire de Lyon,
2 Unite ICE UPSP 2011-03-101, VetArgo Sup, Campus Vétérinaire de 69280, Marcy l’Etoile, France (e-mail: jp.genevois@free.fr).
Lyon, Marcy-l’étoile, France

Vet Comp Orthop Traumatol 2018;31:445–451.

Downloaded by: The University of Edinburgh. Copyrighted material.

Abstract Objectives The main purpose of this article is to evaluate the correlation between the
distraction index (DI) and Norberg angle values in distracted hips (distraction Norberg
angle, DNA) at 4 months of age and the official hip score based on the Fédération
Cynologique Internationale (FCI) grid at 12 months of age.
Methods For dogs (n ¼ 215) from two guide dog training organizations, the DI and
DNA were measured by a single expert on distraction radiographs performed at
4 months of age. The FCI score was determined by the same expert at 12 months of age
on a standard hip-extended view.
Statistical analysis included receiver operating characteristic curve analysis and con-
cordance correlation coefficient calculation.
Results The mean DI was 0.48, the mean DNA was 86.5° and 59.5% of hips had an A
FCI score. The concordance correlation coefficient of DI and DNA was 0.78. The DI
threshold for D- and E-scored hips that was associated with the least misclassification
was 0.58 (sensitivity [Se] ¼ 0.6, specificity [Sp] ¼ 0.82). The DNA threshold that was
Keywords associated with the least misclassification was 85° (Se ¼ 0.83, Sp ¼ 0.68).
► hip dysplasia Clinical Significance DNA has a fair correlation with DI at 4 months and reflects hip
► distraction index passive laxity. D and E FCI scores at 12 months cannot be reliably predicted from the
► distracted Norberg 4 months value of DI or DNA but 96% of hips with DI < 0.58 at 4 months had an A, B or C
angle FCI score at 12 months of age. Similarly, 98% of hips with DNA > 85° at 4 months had an
► FCI grade A, B or C FCI score at 12 months of age.

Introduction
Canine hip dysplasia, first described by G. Schnelle1 in the
1930s, is one of the most common orthopaedic conditions in
dogs, but its precise aetiology remains poorly understood.
Hip dysplasia is a complex disease in which multiple genes
interact, predisposing dogs to developmental malformation
of the hip joints. In predisposed dogs, environmental factors
modify the genetic influence, leading to anatomical anoma-
lies and clinical discomfort. Henricson and colleagues2 in
1966 described canine hip dysplasia as a disease that stems

received © 2018 Georg Thieme Verlag KG DOI https://doi.org/

December 27, 2017 Stuttgart · New York 10.1055/s-0038-1668087.
accepted after revision ISSN 0932-0814.
June 9, 2018
446 Comparison of Distraction Index and FCI Evaluation
from ‘a varying degree of hip laxity of the hip joint permitting
subluxation during early life, giving rise to varying degrees of
shallow acetabulum and flattening of the femoral head,
finally inevitably leading to osteoarthritis’.
Hip dysplasia is a concern in pet dogs but also and
particularly in working dogs. Guide dog training organiza-
tions, for instance, attempt to foresee the evolution of the
dogs enrolled in their training programme by subjecting
their breeding dogs to hip radiographic screening and apply-
ing selection pressure in an attempt to maximize the
improvement in hip joint quality in the offspring. In spite
of these preventive measures, emphasizing the importance
of screening organizations all around the world, mating dogs
with normal hips, even with normally conformed ancestors,
does not produce all normal offspring.3–10
Screening of breeding dogs as well as pet or working dogs
is based on radiographic evaluation. A standard hip-
extended radiograph, in anaesthetized or deeply sedated
dogs, is mostly used for official hip radiographic screening.
The Fédération Cynologique Internationale (FCI) system is
used in continental Europe, Asia, Russia and parts of South
America. It is based on a five-grade (A, B, C, D, E) scoring scale
from A, reflecting a normal hip joint, to E, indicating severe
hip dysplasia. Assessment criteria include the value of the
Norberg angle, degree of subluxation, shape and depth of the
acetabulum and signs of secondary joint disease.11
Hip dysplasia screening tests should minimize false-nega-
tive diagnoses. For working dogs, it is of upmost interest to
rule out from an expensive training programme the indivi-
duals which are most likely to develop osteoarthritis. Hip-
extended radiographic screening is not considered as accu-
rate before 12 months of age at least.12,13 Therefore, FCI
regulation states that the minimal age for official hip grading
is 1 year for most breeds and 18 months for large and giant
breeds. The Orthopedic Foundation for Animals requires
official hip radiographs to be performed on dogs that are
Fig. 1 Box and whisker plots of the distraction index in the total population and in the three most represented breeds.
Veterinary and Comparative Orthopaedics and Traumatology Vol. 31
Taroni et al.
24 months of age or older. Concerns regarding earlier diag-
nosis explain the growing interest in distraction radiographs
in the veterinary literature in the last few decades.
Distraction methods as described by the PennHip orga-
nization14–16 have been shown to be reliable screening
methods to predict hip dysplasia as early as 16 weeks of
age.13,17,18 Norberg angle measurement with the femur in a
neutral position and hips distracted (distraction Norberg
angle, DNA) was first described by Adams and colleagues.13
Compared with the regular Norberg angle measured on the
hip-extended radiograph, DNA is free from the coxofemoral
joint capsule windup19 that limits the lateral movement of
the femoral head. Very few studies report the use of
DNA,13,20 but it may be hypothesized that DNA can be as
reliable as the distraction index (DI) for hip laxity
measurement.
The purpose of this study is to evaluate the correlation
between DI and DNA measured at 4 months of age and the FCI
official hip score determined at 12 months of age.
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Materials and Methods
Data Collection
Radiographic data from dogs (n ¼ 215) from two guide dog
training organizations were collected from one author’s
database (JPG). Dogs had been line-bred for favourable
characteristics, including hip conformation. The population
included mainly Labrador and Golden Retrievers and other
miscellaneous breeds (German Shepherd, Labrador/Golden
cross breed, Labrador/Poodle cross breed, Golden/German
Shepherd cross breed). Radiographs were performed
between January 2013 and December 2016.
At 4 months of age, dogs underwent stress radiographs
using the technique described by Vezzoni and colleagues.21
After a first standard hip-extended radiograph, a ventrodor-
sal compression view was performed, followed by a
No. 6/2018
 Comparison of Distraction Index and FCI Evaluation Taroni et al. 447

Fig. 2 Box and whisker plots of the distraction Norberg angle in the total population and in the three most represented breeds.

Downloaded by: The University of Edinburgh. Copyrighted material.

distraction view using a Vezzoni distractor. At 12 months, a
standard ventrodorsal hip-extended radiograph was per-
formed to obtain an official FCI scoring. The radiographs
were performed on anesthetized dogs in five different veter-
inary practices by five different well-trained veterinarians.
The digital DICOM radiographs were sent to one of the
authors for measurement and evaluation via a dedicated
computerized programme (EasyIMAGE—VetXL, VetZ, Han-
over, Germany).
Hip Evaluation
The DI and DNA were assessed on both hips for all the dogs on
the 4 months radiographs. The FCI official grading from A to E
was performed by the same expert based on the 12 months
hip-extended radiographs.
Statistical Analysis
Each hip was evaluated as an independent joint, regardless of
the other hip of the dog.
The normal distribution of numeric variables was tested
with the Shapiro–Wilk test. The mean and median DI and
DNA were calculated successively for the whole population,
for the Labrador Retriever population, for the Golden Retrie-
ver population and for each of the 5 FCI score categories
among the total population of dogs.
The FCI class was grouped as follows: hips graded A, B, C
were considered clinically acceptable and hips graded D, E
were considered as non-acceptable.22
The threshold analysis of the DI and the DNA was per-
formed with a receiver operating characteristic (ROC) curve
analysis.23

Fig. 3 Distraction index among Fédération Cynologique Internationale categories.

Veterinary and Comparative Orthopaedics and Traumatology Vol. 31 No. 6/2018

448 Comparison of Distraction Index and FCI Evaluation Taroni et al.

Fig. 4 Distraction Norberg angle among Fédération Cynologique Internationale categories.

Downloaded by: The University of Edinburgh. Copyrighted material.

The DNA and DI values were centred and scaled. The
correlation between the centred-scaled variables was eval-
uated with Lin’s concordance correlation coefficient
(CCC).24,25 The CCC is composed of a measure of precision
rho and accuracy C.b. The CCC ranges from 0 to 1, 1 being a
perfect agreement between measurement methods.
The analysis was performed using R 3.4.0 (R Foundation
for Statistical Computing, Vienna, Austria) and the package
pROC. A value of p < 0.05 was considered significant.
Results
In the total population, 167 dogs were Labrador Retrievers,
26 were Golden Retrievers, 8 were German Shepherds, 5
were Labrador/Golden cross breed, 1 was a Labrador/Poodle
cross breed and 8 were Golden/German Shepherd cross
breeds. Among them, 82 were males, 133 were females.
The mean age for the 4-month evaluation was 16.7  0.7
weeks old, and the mean age for the 12-month evaluation
was 54.3  1.8 weeks.
The DI was not normally distributed (p ¼ 0.004) and the
DNA did not significantly diverge from normality (p ¼ 0.06).
The median value of the DI was 0.47 (range values 0.17–0.92)
(►Fig. 1). The median value of the DNA was 86° (range values
68°–105°) (►Fig. 2). Repartition of the FCI scores was 59.5%
(n ¼ 256) A (no sign of hip dysplasia), 21.9% (n ¼ 94) B (near
normal hip joint), 11.2% (n ¼ 49) C (mild hip dysplasia), 4.0%
(n ¼ 17) D (moderate hip dysplasia) and 3.5% (n ¼ 15) E
(severe hip dysplasia). The repartition of the DI values and
the DNA values among the FCI categories are represented in
►Figs. 3 and 4, respectively.
The difference between the ROC curves of DI and DNA was
not significant (Bootstrap test for correlated curves, p ¼ 0.27).
For the DI and DNA, the CCC was 0.78. The precision and
accuracy were rho ¼ 0.78 and C.b ¼ 0.9999983, respectively.
The two methods were on average centred on the same

Table 1 Variation in specificity, sensitivity, positive predictive value and negative predictive value depending on the threshold of
distraction index chosen, for a prevalence of hips graded E or F of 7.42%

Thresholds Specificity Sensitivity Positive predictive value Negative predictive value

0.1 0.0056 1.00 0.0748 1.00
0.2 0.0168 1.00 0.0755 1.00
0.3 0.0702 0.9667 0.0771 0.9632
0.4 0.2865 0.9333 0.0951 0.9816
0.5 0.6152 0.7333 0.1328 0.9663
0.58 0.8146 0.6 0.2064 0.9620
0.6 0.8343 0.5 0.1952 0.9540
0.7 0.9522 0.2333 0.2818 0.9391
0.8 0.9944 0.1 0.5894 0.9321
0.9 1 0.0333 1.00 0.9278

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 Comparison of Distraction Index and FCI Evaluation Taroni et al. 449

The DNA threshold that was associated with the least

misclassification was 85° (Se ¼ 0.83, Sp ¼ 0.68) (►Table 2).
The ROC curve is represented in ►Fig. 6.

Fig. 5 Receiver operating characteristic curve of the ability of the
distraction index to discriminate A, B and C Fédération Cynologique
Internationale (FCI) grade from E and F FCI grades. The black curve
indicates the evolution of the specificity and the sensitivity when the
threshold is modified. The grey line represents a non-informative
index. The closer the black line to the point (1.1) on the top left corner,
the better the performances of the test. The area under the curve is
0.7571.
Discussion
Our results showed that the DI and DNA measured at
4 months of age cannot accurately predict the FCI score at
12 months of age. A fair correlation between DNA and DI
values at 4 months was found.
In the past, it has been questioned whether hip laxity can
be properly assessed on hip-extended radiographs. It is not
considered accurate until the age of 12 months for the
diagnosis of hip dysplasia. At 6 months of age, only 16 to
32% of dogs with hip dysplasia are correctly diagnosed, and at
1 year of age, correct diagnosis is reported for 63 to 69% of
dogs.12,13 On the other hand, several studies have shown that
early DI measurement on a distraction radiograph with the
limbs in a neutral position is a good indicator of passive hip

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values with an almost perfect accuracy. The variation in
measurements was more important but still gave a fair pre-
cision. As a result, the CCC gave an overall fair agreement
between DI and DNA.
The DI threshold that was associated with the least
misclassification was 0.58 (Se ¼0.6, Sp ¼ 0.82) (►Table 1).
The ROC curve is represented in the ►Fig. 5.
laxity and thus a good predictor of canine hip dysplasia in
terms of osteoarthritis development after 2 years of age or
later in the dog’s life.17,26,27 Among the hips which had a FCI
score of A, only 6.2% had a DI 0.3 and 3.1% had DI > 0.7. This
underlines the fact presented above whereby FCI scoring
based on hip-extended radiographs is not accurately related
to passive laxity. The DI threshold associated with the
least misclassification is 0.58 and its associated negative

Table 2 Variation in specificity, sensitivity, positive predictive value and negative predictive value depending on the threshold of
DNA chosen, for a prevalence of hips graded E or F of 7.42%

DNA Thresholds Specificity Sensitivity Positive predictive value Negative predictive value
105 0.0084 1 0.0750 1
103 0.0113 1 0.0752 1
101 0.0226 1 0.0760 1
99 0.0254 1 0.0762 1
97 0.0621 1 0.0789 1
95 0.1356 0.9667 0.0824 0.9806
93 0.2373 0.9667 0.0924 0.9888
91 0.3220 0.9667 0.1028 0.9917
89 0.4633 0.9333 0.1226 0.9885
87 0.5706 0.8667 0.139 0.9815
85 0.6780 0.8333 0.1722 0.9806
83 0.7853 0.6 0.1834 0.9606
81 0.8644 0.4667 0.2167 0.9527
79 0.9350 0.3 0.2706 0.9432
77 0.9520 0.1667 0.2182 0.9343
75 0.9831 0.1667 0.4422 0.9362
73 0.9887 0.1333 0.4867 0.9342
71 0.9944 0.0666 0.4890 0.9298
69 1 0.0333 1 0.9279

Abbreviation: DNA, distraction Norberg angle.

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450 Comparison of Distraction Index and FCI Evaluation
Fig. 6 Receiver operating characteristic curve of the ability of the
distraction Norberg angle to discriminate A, B and C Fédération
Cynologique Internationale (FCI) grade from E and F FCI grades. The
black curve indicates the evolution of the specificity and the sensi-
tivity when the threshold is modified. The grey line represents a non-
informative index. The closer the black line to the point (1.1) on the
top left corner, the better the performances of the test. The area
under the curve is 0.7885.
predictive value is 0.96. This means that 96% of dogs with a
DI < 0.58 have an A, B or C FCI score. These results must be
interpreted with caution due to the overrepresentation of A-
scored hips, the poor representation of E-scored hips in our
population and the poor correlation found between the DI
and FCI score. The PennHIP method and thus the DI mea-
surement have been reported as accurate to predict FCI
scores D and E.28 Our study does not confirm these results
but the poor representation of D and E hips in our population
is a bias for the interpretation of our results regarding this
category of hips. Indeed, 33.3% of hips with a DI > 0.7 had an
FCI score of A, and 19.1% had an E FCI score. It seems peculiar
to claim that dogs with a DI > 0.7 are more likely to have A-
scored hips than E-scored hips.
Measurement of the Norberg angle, which is used in FCI
scoring in adult dogs, in addition to being a poor predictor of
hip laxity,17,29 is not suitable when applied to young dogs
because the craniolateral edge of the acetabulum still has a
cartilaginous component that prevents precise identification
when measuring the Norberg angle.30 Complete ossification
is reported to occur in dogs at 5 months of age.31 In our study,
the measurements of the DNA have been performed in
4 months old dogs, and were not meant to be compared
with DNA in older dogs that would potentially have had a
different range of values, because of the ossification of the
craniolateral edge of the acetabulum. In this way, this
limitation does not apply here. Moreover, the Norberg angle
measurements of femurs in a neutral position on distracted
hips have been reported as a significant predictor of osteoar-
thritis, with a lesser sensitivity than DI.13,20 Our results show
a fair correlation between DI and DNA with a CCC of rho
¼ 0.78, suggesting that DNA is a proper indicator of hip joint
laxity and thereby of osteoarthritis risk, even if measured as
young as 4 months of age. However, the DI and DNA values
are not perfectly interchangeable. This relative imprecision
may be explained by the aforementioned anatomical feature
of the juvenile acetabulum. Even though the good repeat-
Veterinary and Comparative Orthopaedics and Traumatology Vol. 31 No. 6/2018
Taroni et al.
ability of the DI measurement has been reported by the
PennHIP organization,32 it might not be the case for the DNA
measurement at 4 months, that is, before the ossification of
the craniolateral edge of the acetabulum. This might have
diminished the importance of the correlation.
In conclusion, DNA is correlated with DI in 4-month-old
dogs. The DNA may be an interesting indicator and should
undergo further consideration to determine if it can offer
complementary information to refine early hip laxity eva-
luation. The FCI grades at the age of 12 months have a poor
correlation with DI and DNA, but our results suggest that a
threshold of 0.58 for the DI or 85° for the DNA at 4 months
can accurately predict A, B or C-scored hips at 12 months.
Funding
This research did not receive any specific grant from
funding agencies in the public, commercial or not-for-
profit sectors.
Downloaded by: The University of Edinburgh. Copyrighted material.
Conflict of Interest
None.
Author Contributions
All authors contributed to conception of study, study
design, and acquisition of data and data analysis and
interpretation. All authors drafted, revised and approved
the submitted manuscript.
Acknowledgment
The authors acknowledge the two schools of guide dogs
for blind people and the veterinarians collaborating with
these schools, who performed the radiographs.
References
1 Schnelle GB. Congenital subluxation of the coxofemoral joint in
the dog. Univ Pa Bull 1937;65:15–16
2 Henricson B, Norberg I, Olsson SE. On the etiology and pathogen-
esis of hip dysplasia: a comparative review. J Small Anim Pract
1966;7(11):673–688
3 Jessen CR, Spurrell FA. Radiographic detection of canine hip
dysplasia in known age groups. Proceedings of the Canine Hip
Dysplasia Symposium and Workshop; October 19-20, 1972; St.
Louis, Missouri, United States. 93–100
4 Snavely JG. The genetic aspects of hip dysplasia in dogs. J Am Vet
Med Assoc 1959;135(04):201–207
5 Kaman CH, Gossling HR. A breeding program to reduce hip
dysplasia in German shepherd dogs. J Am Vet Med Assoc 1967;
151(05):562–571
6 Henricson B, Ljunggren G, Olsson SE, et al. Hip dysplasia in
Sweden: controlled breeding programs. Proceedings of the
Canine Hip Dysplasia Symposium and Workshop; 1973; Colum-
bia, Missouri, United States. 141–151
7 Riser WH. An analysis of the current status of hip dysplasia in the
dog. J Am Vet Med Assoc 1964;144:709–721
8 Hedhammar A, Olsson SE, Andersson SA, et al. Canine hip dys-
plasia: study of heritability in 401 litters of German Shepherd
dogs. J Am Vet Med Assoc 1979;174(09):1012–1016
9 Boernfors S, Palsson K, Skude G. Hereditary aspects of hip
dysplasia in German Shepherd dogs. J Am Vet Med Assoc 1964;
145:15–20
 Comparison of Distraction Index and FCI Evaluation
10 Jenny-Gredig V, Kieliger J, Müller A, Eggenberger E. Today’s status
of the hip joint dysplasia control in Switzerland [Article in Ger-
man]. Schweiz Arch Tierheilkd 1970;112(09):487–490
11 Flückiger M. Scoring radiographs for canine hip dysplasia - the big
three organisations in the world. Eur J Companion Anim Pract
2007;17:135–140
12 Jessen CR, Spurrell FA. Radiographic detection of canine hip
dysplasia in known age groups. In: Proceedings of the Canine
Hip Dysplasia Symposium and Workshop, St Louis, MO; 1972: 93–
100
13 Adams WM, Dueland RT, Meinen J, O’Brien RT, Giuliano E,
Nordheim EV. Early detection of canine hip dysplasia: comparison
of two palpation and five radiographic methods. J Am Anim Hosp
Assoc 1998;34(04):339–347
14 Smith GK, Biery DN, Gregor TP. New concepts of coxofemoral joint
stability and the development of a clinical stress-radiographic
method for quantitating hip joint laxity in the dog. J Am Vet Med
Assoc 1990;196(01):59–70
15 Smith GK, Gregor TP, McKelvie PJ, et al. PennHIP Training Seminar
and Reference Material, Synbiotics Corporation, San Diego; 2002
16 Powers MY, Karbe GT, Gregor TP, et al. Evaluation of the relation-
ship between Orthopedic Foundation for Animals’ hip joint scores
and PennHIP distraction index values in dogs. J Am Vet Med Assoc
2010;237(05):532–541
17 Smith GK, Gregor TP, Rhodes WH, Biery DN. Coxofemoral joint
laxity from distraction radiography and its contemporaneous and
prospective correlation with laxity, subjective score, and evidence
of degenerative joint disease from conventional hip-extended
radiography in dogs. Am J Vet Res 1993;54(07):1021–1042
18 Smith GK, Hill CM, Gregor TP, Olson K. Reliability of the hip
distraction index in two-month-old German shepherd dogs. J Am
Vet Med Assoc 1998;212(10):1560–1563
19 Heyman SJ, Smith GK, Cofone MA. Biomechanical study of the
effect of coxofemoral positioning on passive hip joint laxity in
dogs. Am J Vet Res 1993;54(02):210–215
20 Adams WM, Dueland RT, Daniels R, Fialkowski JP, Nordheim EV.
Comparison of two palpation, four radiographic and three ultra-
sound methods for early detection of mild to moderate canine hip
dysplasia. Vet Radiol Ultrasound 2000;41(06):484–490
Taroni et al. 451
21 Vezzoni A, Dravelli G, Corbari A, et al. Early diagnosis of canine hip
dysplasia. Eur J Companion Anim Pract 2005;15:173–184
22 Malm S, Fikse F, Egenvall A, et al. Association between radio-
graphic assessment of hip status and subsequent incidence of
veterinary care and mortality related to hip dysplasia in insured
Swedish dogs. Prev Vet Med 2010;93(2-3):222–232
23 Robin X, Turck N, Hainard A, et al. pROC: an open-source package
for R and Sþ to analyze and compare ROC curves. BMC Bioinfor-
matics 2011;12:77
24 Lin LI. A concordance correlation coefficient to evaluate reprodu-
cibility. Biometrics 1989;45(01):255–268
25 Lin K. A note on the concordance correlation coefficient. Bio-
metrics 2000;56:324–325
26 Smith GK, Mayhew PD, Kapatkin AS, McKelvie PJ, Shofer FS,
Gregor TP. 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(12):1719–1724
27 Runge JJ, Kelly SP, Gregor TP, Kotwal S, Smith GK. Distraction index
as a risk factor for osteoarthritis associated with hip dysplasia in
four large dog breeds. J Small Anim Pract 2010;51(05):264–269
28 Ginja MM, Gonzalo-Orden JM, Melo-Pinto P, et al. Early hip
laxity examination in predicting moderate and severe hip
Downloaded by: The University of Edinburgh. Copyrighted material.
dysplasia in Estrela mountain dog. J Small Anim Pract 2008;
49(12):641–646
29 Gaspar AR, Hayes G, Ginja C, Ginja MM, Todhunter RJ. The Norberg
angle is not an accurate predictor of canine hip conformation
based on the distraction index and the dorsolateral subluxation
score. Prev Vet Med 2016;135:47–52
30 Vezzoni A, Dravelli G, Vezzoni L, et al. Comparison of conservative
management and juvenile pubic symphysiodesis in the early
treatment of canine hip dysplasia. Vet Comp Orthop Traumatol
2008;21(03):267–279
31 Fujiki M, Kurima Y, Yamanokuchi K, Misumi K, Sakamoto H.
Computed tomographic evaluation of growth-related changes
in the hip joints of young dogs. Am J Vet Res 2007;68(07):730–734
32 Smith GK, LaFond E, Gregor TP, Lawler DF, Nie RC. Within- and
between-examiner repeatability of distraction indices of the hip
joints in dogs. Am J Vet Res 1997;58(10):1076–1077
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