Lecture 11 2/10/25 Flashcards
What are the characteristics of hip luxation?
-most common joint luxation
-vast majority are craniodorsal
-may see ventral or rarely caudodorsal luxation
-generally associated with trauma
-luxation with mild trauma should be a red flag for hip dysplasia and secondary hip luxation
What keeps the hip in place?
-ball and socket joint
-ligament of the head of the femur
-joint capsule
-periarticular muscles, especially gluteals
What are the physical exam findings suggestive of hip luxation?
-loss of the “triangle” sign; becomes a straight line
-hock internally rotated while foot and hip are externally rotated
-loss of thumb notch test
-ventral luxation: greater trochanter moved distal and medial
What should be looked for on radiographs in patients with hip luxation?
-signs of hip dysplasia in patients that luxated with minimal trauma
-bone fragments in the acetabulum; avulsion fracture
What are the treatment options for hip luxation?
-closed reduction
-surgery, including femoral head and neck excision or total hip replacement
What are the characteristics of closed reduction for hip luxations?
-can only be done if there is no other hip trauma
-pet must be under general anesthesia
-around 50% success rate
What are the steps of a closed reduction for hip luxations?
-hang leg for 10 to 15 minutes
-apply counter traction with a towel, external rotation of the femur, and distal traction
-apply internal rotation-abduction push on the greater trochanter; should feel/hear a distinct clunk
-apply pressure on the greater trochanter and rotate the hip for 5 minutes
-perform gentle range of motion and “test” stability; hips that come right back out require surgery
-place leg in an ehmer sling for 2 weeks
What are the characteristics of the ehmer sling?
-flexed and non-weight-bearing
-internal rotation of hip
-external rotation of hock
-nearly 100% morbidity; causes skin irritation, toe swelling, ulceration
-commercially available; less morbidity but less rotation
What are the characteristics of closed reduction for a ventral hip luxation?
-abduct femur
-apply traction
-will feel it slip out from under pelvis and pop back in
-hobbles after reduction for 2 weeks to prevent “doing the splits” and reluxating
What are the surgery options for hip luxation?
-capsulorrhaphy
-prosthetic capsule
-transposition of greater trochanter distally and caudally to increase gluteal muscle tension
-toggle pin
-suture from iliopubic eminence to lesser trochanter
-triple pelvic osteotomy
-femoral head and neck excision
-total hip replacement
What are the characteristics of elbow luxation?
-traumatic
-can be congenital in toy and miniature breeds with deformed elbows
-lateral luxation is more common due to smaller lateral epicondyle
-elbow is inherently stable; takes lots of force to luxate
What are the clinical findings in elbow luxation?
-history of trauma
-non-weight-bearing
-carry the limb and antebrachium externally rotated
-loss of normal anatomic landmarks with palpation
-painful with manipulation
-can have crepitus
-confirmed on radiographs
What are the steps to closed reduction of elbow luxation?
-put pet under GA
-hang leg for 10 minutes to fatigue muscles
-may be able to push on radial head and pop elbow back in
-otherwise, flex elbow to move anconeal process away from supratrochlear foramen
-apply pressure on radial head while internally rotating antebrachium
-maintain in a spica splint for 2 weeks to keep elbows extended
-restrict activity for 2 months with cautious ROM
What are the steps to surgical treatment for elbow dysplasia?
-take a caudolateral approach to the elbow
-debride joint and remove any fragments
-reduce luxation
-apply prosthetic collateral ligament with screws, washers, and figure of 8 leader line suture
What are the characteristics of shoulder luxation?
-less common
-occurs with trauma
-medial luxation is most common
-congenital medial luxation can occur with toy and miniature breeds; often due to dysplastic joint
-shoulder joint is less stable than other joints
What are the clinical findings in traumatic shoulder luxations?
-history of trauma
-acute lameness, usually non-weight-bearing
-abnormal relationship between acromion process and greater tubercle
What are the clinical findings in congenital shoulder luxations?
-seen in toy breeds and puppies
-lameness with possible muscle contracture
-abnormal relationships between acromion process and greater tubercle
What are the steps to conservative treatment for shoulder luxation?
-put pet under GA
-hang leg to fatigue muscles
-push humeral head laterally while distracting for medial luxation
-apply velpeau sling for medial luxation; spica splint for lateral luxation
-keep sling/splint on for 2 weeks and then restrict activity for an additional 4 to 6 weeks
What are the characteristics of a velpeau sling?
-maintains shoulder and elbow in flexed position
-drives humeral head laterally if medial shoulder luxation
-should not be used for lateral luxations
What are the steps to surgical treatment of a shoulder luxation?
-reconstruct soft tissues such as joint capsule and subscapularis muscle
-transpose biceps tendon; go to a more medial location for medial luxation to help pull humerus more laterally
-install prosthetic collateral ligament
-apply sling or splint post-op for 2 weeks; restrict activity for an additional 4 to 6 weeks
Which other surgical technique can be used for medial shoulder luxation?
tightrope suture technique
