58. Coxofemoral luxation

Question 1

What are the periarticular muscles of the coxofemoral joint

Answer 1

Superficial, middle, and deep glutealsQuadratus femorisGemelliInternal obturatorExternal obturatorIliopsoas

Question 2

T/FIn immature animals, capital physical fx occurs more often than coxofemoral luxation

Answer 2

TrueSH type I

Question 3

Physical examination of a dorsal vs ventral hip luxation

Answer 3

75% Dorsal: shortening, adduction w external rotation, crepitus, asymmetry, increase distance btwn greater trochanter and ischiatic tuberosity Ventral: lengthening, abduction w internal rotation

Question 4

Primary and secondary coxofemoral joint stabilizers

Answer 4

Primary stabilizers –Joint capsule–Round ligament or ligament of the head of the femur–Dorsal acetabular rimSecondary stabilizersHydrostatic pressure btwn joint fluid and periarticular muscles Acetabular labrumTransverse acetabular ligamentPeriarticular muscles (Gluts, Quad, Obturators, Iliopsoas, Gemeli)

Question 5

T/FAttempted closed reduction prior to surgery does not effect long term prognosis

Answer 5

True1984 vet surgery Bone et al

Question 6

Indications for open reduction of coxofemoral luxation

Answer 6

Failed closed reductionAcetabular and/or femoral head fractures also presentConcurrent injuryChronic luxation wh requires cartilage evaluation

Question 7

Augmentation of closed reduction for coxofemoral luxation

Answer 7

Ehmer sling (internal rotation, abduction, hip flexion) for 10-14 days; for craniodorsal luxationsHobbles for caudoventral luxations-prevent limb abductionIschioilial pinning (DeVita pinning) for 2-4 weeks; complications 32% of which 75% are sciatic nerve injury! ESF 2-4 weeks (pins in proximal femur and ilium)Transarticular pinning through open or closed approach

Question 8

1991 VCOT Beale, Lewis et alConfirmed what reduction rate w DeVita pinning?

Answer 8

1991 VCOT Beale and Lewis et al al 21 dogs w DeVita 73% maintained reduction32% complications ( sciatic nerve injury, pin migration, joint sepsis, damage to femoral head, reflux)

Question 9

success rate in general for open surgical reduction of coxofemoral luxation

Answer 9

85%craniolateral approach +/- tenotomy deep gluteal +/- osteotomy of greater trochanter (may allow transposition caudal and distal)

Question 10

List open reduction repair methods for craniodorsal coxofemoral luxation (13)

Answer 10

1. primary capsulorrhapy2. prosthetic capsulorrhapy (bone anchors/screws, washer, suture)3. Deep gluteal tendonesis4. Toggle rod5. Devita ischio-ilial pinning6. caudal and distal greater trochanter transposition7. Transarticular pinning8. fascia lata loop stabilization9. extra articular ilial femoral suture10. sacrotuberous ligament transposition11. FHO12. TPO13. THR

Question 11

reluxation rate following toggle rod stabilization

Answer 11

11% reluxate with the majority of relax occurring > 7 d post opother reports said as high as 25% (but small case numbers)

Question 12

T/FTrochanteric transposition is recommended for ventral coxofemoral luxation repair

Answer 12

FALSEtrochanteric transposition is NOT recommended for stabilization of ventral luxation

Question 13

list methods of repair for ventral coxofemoral luxation

Answer 13

1. primary capsulorrhapy2. prosthetic capsulorrhapy3. Toggle rod4. Repair ventral transverse acetabular ligament5. iliac crest autogenous graft to augment ventral acetabular shelf6. FHO7. THR