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Ortho > Joint Luxations > Flashcards

Joint Luxations Flashcards

1
Q

What is the most common direction for a coxofemoral luxation?

A
  • Craniodorsal (70%)
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2
Q

What is the second most likely direction for a coxofemoral luxation?

A
  • Caudoventral
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3
Q

What are most common causes of coxofemoral luxation?

A
  • Trauma (motor vehicle accident, jumped/dropped)
  • Unknown
  • Non-weight bearing lame
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4
Q

Physical exam findings of coxofemoral luxation (craniodorsal luxation)?

A
  • Craniodorsal luxation: Stifle externally rotated and limb adducted
  • Pain/discomfort at the hip
  • Non-weight bearing
  • Loss of the “hip triangle” (craniodorsal luxation)
  • Short limb
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5
Q

Physical examination findings for caudoventral luxation?

A
  • Stifle internally rotated and hip abducted
  • Pain/discomfort at hip
  • Non-weight bearing
  • Decreased greater trochanter
  • Longer limb
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6
Q

Diagnosis of hip luxation?

A
  • Orthogonal view radiographs
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7
Q

What can you see on radiographs with a hip luxation?

A
  • Looking for any fragments from an avulsion fracture of the round ligament
  • Also confirming the direction of displacement
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8
Q

When to do closed vs open hip reduction?

A
  • Closed reduction is best done within 5-7 days (50%) success
  • Open reduction is best performed if femoral head does not stay reduced, or if you are >7 days post trauma, or if there are avulsion fractures (85-90% success)
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9
Q

What is “post-reduction” treatment for a closed reduction?

A
  • Ehmer sling for 10-14 days
  • Restrict activity for 4-6 weeks
  • keeping the limb abducted and internally rotated
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10
Q

What treatment do you use for caudoventral hip luxation (we didn’t talk about in class)?

A
  • Hobbles
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11
Q

What is post-op care for an closed reduction?

A
  • +/- Ehmer Sling bandage for 7-10 days post-op

- Restrict activity for 4-6 weeks

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12
Q

If the hip will not stay reduced with a closed reduction, what are surgical options to consider?

A
  • Femoral head and neck ostectomy

- Total hip replacement

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13
Q

Techniques of open reduction

A
  • Capsulorraphy (suture capsule back together)
  • Toggle pin (new prosthetic ligament of teres by tunneling between subtrochanteric fossa out of the femoral neck and fovea)
  • Transarticular pinning
  • Prosthetic capsule
  • DeVita Pinning (sciatic nerve)
  • Transposition of greater trochanter
  • Must completely debride the coxofemoral joint
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14
Q

Complications of traumatic coxofemoral joint luxation?

A
  • Reluxation (can happen with open or closed); often indicates underlying canine hip dysplasia
  • 2° osteoarthritis
  • Infection (open)
  • Revision surgery: FHNO, THRA
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15
Q

Prognosis for lame free function for a craniodorsal coxofemoral joint luxation

A
  • Good to very good
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16
Q

What is the direction for most traumatic shoulder luxations, and who gets traumatic medial shoulder luxations?

A
  • 75% medial (small breeds)

- large breeds get lateral

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17
Q

How common are cranial or caudal shoulder luxations?

A
  • Generalized instability
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18
Q

What direction are most congenital shoulder luxations, and who gets them?

A
  • medial

- Spontaneous in toy breeds (medial patella luxation)

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19
Q

History of shoulder luxations

A
  • Variable; +/- trauma or spontaneous
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20
Q

Physical examination of shoulder luxations

A
  • Toe touching or non-weight bearing (traumatic)
  • Weight-bearing +/- lameness (congenital or “chronic” traumatic)
  • Abducted and externally rotated
  • Shoulder joint swelling
  • Altered anatomy between the acromion of the scapular and greater tubercle of the humerus (for medial luxation; acromion may be pretty prominent)
  • Pain on palpation/manipulation of the shoulder joint
  • Joint instability on palpation
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21
Q

What direction is the shoulder rotated with a medial shoulder luxation?

A
  • Abducted and externally rotated
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22
Q

Diagnostics for shoulder luxations

A
  • Radiographs (orthogonal views)
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23
Q

Diagnostics for congenital luxations

A
  • Malformation of the glenoid and humeral head

- Radiographs (orthogonal views)

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24
Q

When to use closed reduction for shoulder luxation (and what would you use for a medial vs lateral luxation)?

A
  • Recent traumatic luxations
  • Velpeau sling for medial luxation (2 weeks)
  • Spica splint for lateral luxation (2 weeks)
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25
Q

When to use open reduction for a shoulder luxation (and what treatments would you use)?

A
  • If unstable, can’t reduce, concurrent fractures, or recurrence
  • Capsulorrhaphy, imbrication of surrounding tissues +/- biceps brachii tendon transposition excisional arthroplasty of the humeral head
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26
Q

Treatment for congenital luxations

A
  • Excisional arthroplasty of the humeral head
  • Arthrodesis
  • Biceps brachii tendon transposition not rewarding
  • Hard to do
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27
Q

What is the anatomy for medial shoulder instability?

A
  • Medial glenohumeral ligament, which provides passive stabilizers
  • Subscapularis tendon on the medial side
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28
Q

Who gets medial shoulder instability?

A
  • Repetitive motion injury in sporting and agility dogs
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29
Q

What happens with medial shoulder instabilities?

A
  • Partial or complete disruption of the ligament and/or tendon
  • 80% of shoulder-based instabilities
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30
Q

History of medial shoulder instability

A
  • Chronic or persistent weight-bearing lameness
  • variable response to NSAIDs and rest
  • Gets worse with exercise
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31
Q

Physical examination findings for medial shoulder instability

A
  • Pain on flexion or extension; marked with abduction
  • Lateral drawer sign (humerus held neutral to glenoid and laterally lifted, which will be more pronounced with medial disruption of the joint capsule)
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32
Q

Diagnostics for medial shoulder instability

A
  • Radiographs: Often have developed osteoarthritis in 50% of cases
  • Arthroscopy must be done
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33
Q

Therapy for medial shoulder instability

A
  • Radiofrequency based capsular shrinkage, which has mixed results
  • Restrict for 4-6 weeks wit Hobbles
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34
Q

Prognosis for medial shoulder instability

A
  • Guarded to good
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35
Q

What direction are most traumatic elbow luxations?

A
  • Lateral luxations

- Medial side of the humeral condyle is longer and more resistant to popping out

36
Q

History of traumatic elbow luxations

A
  • Often trauma is unknown
37
Q

Physical examination for elbow luxations

A
  • Toe touching lameness or non-weight bearing
  • Foot does not touch the ground when standing or sitting )similar to fibrotic contracture of the infraspinatus tendon)
  • Antebrachium and foot are abducted
  • Elbow flexed
  • Pain and increased elbow width
  • Resistance to flexion
38
Q

Diagnostics for elbow luxations

A
  • Radiographs (2 view)
39
Q

When to do closed reduction for elbow luxation?

A
  • If recent injury
40
Q

How to stabilize a luxated elbow post reduction?

A
  • Modified Robert Jones (reinforced), 5-7 days

- Restricted leash activity for 2+ weeks

41
Q

When to do an open reduction for an elbow luxation?

A
  • If not stable post closed reduction (especially with collateral ligament constraint loss)
  • Cannot reduce
  • Associated fractures
42
Q

Prognosis for lame free function for elbow luxations

A
  • Very good to excellent
43
Q

What determines prognosis for lame free function for elbow luxations?

A
  • Based on resulting articular trauma and use of physical therapy
44
Q

How common is traumatic luxation of the stifle?

A
  • Uncommon traumatic injury in dogs and cats
45
Q

What occurs as a side effect of traumatic luxation of the stifle?

A
  • Derangement of passive stifle joint stabilizers
  • Collateral ligaments
  • Cruciate ligaments
  • +/- menisci
  • Usually joint capsule intact
46
Q

History for traumatic luxation of the stifle

A
  • +/- trauma known

- Acute onset of non-weight bearing lameness

47
Q

Physical examination for traumatic luxation of the stifle

A
  • Weight-bearing to non-weight-bearing lame
  • Cranial and caudal drawer, genu valgus and/or varus
  • +/- crepitus
  • Marked swelling of stifle joint
  • Pain on palpation
48
Q

Diagnostics for traumatic luxation of the stifle

A
  • Radiographs (orthogonal)
49
Q

Treatment overview for traumatic luxation of the stifle

A
  • Temporary trans-articular pinning

- Reconstruction of ligamentous constrains and trans-articular external skeletal fixator

50
Q

Temporary trans-articular pinning procedure

A
  • 5-7 weeks
  • Reinforced bandage/splint for duration of pinning
  • Stifle held at 30-40 degrees
  • Expect reduction of 30-40 degrees of range of motion
51
Q

What is recommended if there is poor function following trans-articular pinning surgery?

A
  • Arthrodesis, total knee replacement
52
Q

Reconstruction of ligamentous constraints and trans-articular external skeletal fixator how long and prognosis?

A
  • 6 weeks

- Lame-free function can be good (rehab required)

53
Q

Which joints can be affected in carpal sprains and luxations?

A
  • Antebrachiocarpal joint
  • Middle carpal joint
  • Carpometacarpal joint
54
Q

What can be a common comorbidity with carpal sprains and luxations?

A
  • Avulsion fractures of carpal bones
55
Q

History for carpal sprains and luxations?

A
  • Maybe known trauma
56
Q

Physical examination for carpal sprains and luxations

A
  • Weight-bearing to non-weight bearing lameness
  • May be palmigrade during gait and standing
  • Swelling over carpus
  • Pain on extension of carpus +/- crepitus
  • Hyperextendable carpus
  • Producible carpal valgus and/or varus
57
Q

Diagnostics for carpal sprains and luxations?

A
  • radiographs +/- stressed views
58
Q

Treatment for 1° or 2° carpal sprains with no instability

A
  • Splinting for 3-4 weeks
  • leash restraint for 6 weeks
  • If palmigrade or remains lame, consider arthrodesis
59
Q

Treatment for instability or carpal fractures (expected with 3° sprains)

A
  • Pancarpal arthrodesis

- Coaptation (bivalve cast) for 6-10 weeks

60
Q

What can cause tarsal sprain or luxation?

A
  • Trauma can cause both hyperextension and shearing injuries to the tarsus
61
Q

Which tarsal joints are at greatest risk of sprain or luxation?

A
  • Tarsocrural
  • Proximal intertarsal
  • DIstal intertarsal
  • Tarsometatarsal joints at risk
62
Q

Possible comorbidities with tarsal sprain or luxation

A
  • Avulsion and direct fractures of the tarsal bones are possible
  • Sprains, subluxations, and luxations can also involve both plantar and dorsal ligamentous support
  • Short and long sections of the collateral ligaments
63
Q

History for tarsal sprain/luxation?

A
  • +/- known trauma

- Acute lameness

64
Q

Physical examination for tarsal sprain/luxation?

A
  • Swelling of the tarsus
  • Malalignment of tarsocrural joint or other areas of tarsus
  • If shearing injury, exposure of tarsal bones
  • Instability and pain on palpation
  • May ambulate and stand with plantigrade position
65
Q

Diagnostics for tarsal sprain/luxation

A
  • Radiograph

- +/- stress views

66
Q

Treatment for 1° or 2° sprains with no gross instability for a tarsal sprain or luxation

A
  • Coaptation for 3-4 weeks

- If unstable after treatment, surgery

67
Q

Treatment for 3° sprains with/without shearing injuries with gross instability

A
  • Open wound management (shearing injuries) FIRST
  • Temporary transarticular external fixator can be helpful
  • Arthrodesis later if necessary
68
Q

Closed management for 3° sprains

A
  • Pantarsal arthrodesis (tarsocrural joint)
  • Partial arthrodesis (proximal, distal intertarsal joint, tarsometatarsal joint)
  • Coaptation (bivalve cast) 8-12 weeks
69
Q

What can be sequela for joint luxations?

A
  • Osteoarthritis
70
Q

Collateral ligament injuries are also known as what?

A
  • Extra-articular sprains
71
Q

Comorbidities with collateral ligament injury

A
  • Rarely involved as a single injury

- Not uncommon to have concurrent degloving and shearing injuries with carpal and tarsal injuries

72
Q

Injury classification for collateral ligament injury

A
  • 1° sprain
  • 2° sprain
  • 3° sprain
73
Q

1° sprain definition (collateral ligament sprain)

A

Minor stretch or tear

74
Q

2° sprain definition (collateral ligament sprain)

A

Moderate stretch or tear

75
Q

3° sprain definition (collateral ligament sprain)

A
  • Tearing/rupture, avulsion
76
Q

When is surgery indicated for collateral ligament sprains?

A
  • 3° and some 2° sprains
77
Q

WHere are collateral ligaments most common?

A
  • Distal joints (carpus and tarsus)
78
Q

Clinical signs for collateral ligament injury?

A
  • Joint effusion
  • Discomfort over affected area of joint capsule
  • Non-weight bearing
  • Varus (LCL) or valgus (MCL) instability
79
Q

Diagnostics for collateral ligament injury

A
  • Radiographs with stress views

- May see an avulsion component

80
Q

Treatment for a 1° or 2° collateral ligament sprain

A
  • Ice (24-72 hours post injury)
  • Heat (after 72 hours)
  • NSAIDs for 5-7 days
  • Splint or bivalve cast for 4-6 weeks
  • Restrict activity for 6-8 weeks
81
Q

Treatment for 3° or some 2° collateral ligament sprain

A
  • Primary repair (going in and suturing together ligaments)

- Secondary repair (prosthetic suture ) - splint/coapt for 4-6 weeks and restrict activity for 6-8 weeks

82
Q

What treatment for severe disruption of collaterals or other supporting ligamentous structures for collateral ligament injury?

A
  • Arthrodesis
83
Q

If there is a concurrent degloving or shearing injury, do you treat the wound before or after treating the collateral ligament injury definitively?

A
  • Wait until after wound is healed
84
Q

Prognosis for 1° or 2° sprain

A
  • Very good to excellent if stable following treatment
85
Q

Prognosis for 3° or some 2° sprain

A
  • Primary repair or secondary repair
  • Very good to excellent if stable following treatment
  • If degloving or shearing injury is not addressed first, then higher probability of infection (septic arthritis and/or osteomyelitis)
  • If instability is not completely addressed, then osteoarthritis may manifest itself clinically
86
Q

Which joint luxations should have closed reductions attempted first?

A
  • Hip, shoulder, elbow
87
Q

When should attempts at closed reductions not be attempted first?

A
  • Stifle, carpus, tarsus

Ortho (10 decks)

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