22/10/2026
IF A DOG HAS HIF BUT NO LAMENESS, SHOULD WE OPERATE?
This is one of the more challenging questions in veterinary orthopaedics.
A dog has a humeral intracondylar fissure (HIF), but is clinically comfortable.
Do we recommend prophylactic surgical stabilisation to reduce the risk of fracture?
Or do we monitor, accepting that some dogs will never develop clinically significant problems?
A September 2026 review by Walton and Clark examines this question using the available evidence and an interesting statistical approach.
What happens if we don't operate?
One study followed 34 elbows with subclinical HIF in 30 English springer spaniels.
Of those 34 elbows:
-18% (6/34) subsequently fractured.
-A further 6% (2/34) became painful and required transcondylar screw placement.
-Overall, approximately 24% required surgical intervention during follow-up.
This means that most elbows in this cohort did not require surgery during the study period. But a proportion experienced a potentially serious fracture.
What about the risks of prophylactic surgery?
Surgery itself carries risks, including infection, implant complications and the potential need for further intervention.
The authors use two statistical concepts to explore this balance:
-Number Needed to Treat (NNT):
How many patients need treatment for one to benefit? Using the available estimates, the authors calculate an NNT of approximately 5.In other words, around five dogs would need prophylactic treatment to prevent one adverse outcome, based on the assumptions used.
-Number Needed to Harm (NNH):
How many patients need treatment before one experiences a significant treatment-related complication? Using a 6% major complication rate, the estimated NNH is approximately 17. However, if the major complication rate rises to 20%, the NNH falls to just 5.
These figures are illustrative estimates, not definitive predictions. They depend on the populations, implants, surgical techniques and complication rates being compared. While surgical stabilisation is generally recommended due to the potential risk of progression to a complete humeral condylar fracture, the decision still requires careful consideration. The risks associated with surgery must be balanced against the potential consequences of leaving an intracondylar fissure untreated, even in an animal that currently has no clinical signs.
Reference: Walton B, Clark R. (2026). In Practice.
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