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32 Cards in this Set
- Front
- Back
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clinical signs of hip luxation? |
craniodorsal luxation= most common NWB lameness limb adducted asymmetry- greater trochanter displaces dorsally and increased distance from ischial tuberosity to trochanter shortening of affected limb when extension of both limbs evenly backwards |
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radiographic signs of hip luxation?
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check for pelvic or avulsion fractures assess presence of hip dysplasia as closed reduction will be less likely to succeed take 2 views |
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what are the three options for management of hip luxation? |
closed reduction open reduction salvage procedures |
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when is closed reduction more likely to succeed? |
if hip conformation normal if unilateral if no other orthopaedic injuries |
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why might reluxation after closed reduction occur? |
soft tissues eg haematoma and joint capsule trapped in acetabulum |
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how do you perform closed reduction? |
convert luxation to CD luxation and reduce put through full ROM assess stability ehmer sling prevents weight bearing |
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what are the indications for open reduction of hip luxation? |
if closed fails if reluxates if acetabular fracture if hip dysplasia or OA if contralateral limb injury |
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what structure of the joint should you try to repair/ preserve in open reduction of hip luxation? |
joint capsule- use PDS |
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what are some techniques of open reduction? |
iliofemoral suture dorsal capsulorhaphy toggle pin fixation transarticular pin |
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describe iliofemoral suture procedure |
craniolateral approach bone tunnels prepared in femoral neck and ventral ilium cranial to hip suture with hip abducted and stifle joint internally rotated figure of 8 suture |
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describe dorsal capsulorhaphy procedure |
greater trochanter osteotomy to privide access to the dorsal acetabular rim. suture anchor points in dorsal acetabular rim eg screws and flat washers to act as prosthetic joint capsule. reattach greater trochanter distally and caudally to increase tension in gluteal mm, improving medially directed forces. heavy suture material achorded through transverse bone tunnel in femoral neck and around screws in dorsal acetabular rim |
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what is the toggle pin fixation aiming to replace? |
LFH |
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what are the two salvage procedures for hip luxation? |
femoral head and neck excision total hip arthroplasty |
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what is the pathogenesis of avascular necrosis of the femoral head? |
inherited in some breeds- yorkies unknown aetiology inadequate blood supply to the femoral head during development causes avascular necrosis, trabecular collapse, inadequate cartilage support and collapse of the femoral head when weight baring. |
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what are the clinical signs of avascular necrosis of the femoral head? |
progressive HL lameness from 5 mo crouched stance bunny hop pain and crepitus on manipulation reduced ROM |
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radiographic signs of avascular necrosis of femoral head? |
VD extended is most useful focal areas of lucency within head n neck trabecular collapse= increased density looks patchy joint incongruity secondary degenerative changes eg OA |
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how could you treat avascular necrosis of femoral head? |
femoral head and neck excision |
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describe procedure of femoral head and neck excision |
craniolateral approach to maintain gluteal integrity luxate femoral head remove entire head and neck take post op radiograph |
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what are the results of femoral head and neck excision? |
adequate to excellent smooth flat surface lies against acetabulum fibrous pseudoarthrosis forms limb length and ROM reduced but PAIN FREE |
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FHNE post op care? |
rest for 7-10dayes then encourage exerise expect good function by 4-6wks |
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what is the primary lesion of hip dysplasia? |
hip laxity- disparity between skeletal and muscular growth |
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what does hip laxity allow? |
hip subluxation |
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what are the consequences of hip laxity and subluxation in skeletally immature dogs? |
forces are unevenly distributed over the acetabulum and femoral head- concentrated over small area. this causes microfracture, tearing of sharpeys fibres, cartilage degeneration and synovitis. pain changes lead to altered remodelling and remodelling in attempt to stabilise joint eg femoral head flattens and infilling of acetabulum with fibrous tissue |
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what are the clinical signs of hip subluxation in young dogs? |
associated with pain: poor HQ m development lame difficulty rising after lying rolling gait bunny hop when run audible noise with hip movement pain and crepitus on manipulation clinical signs often improve at about 1 year of age |
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why might clinical signs of hip subluxation recur when dog older?
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secondary degenerative changes establish from middle age onwards |
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what are the clinical signs in older dogs? |
associated with secondary OA: stiff on rising stiff after exercise lame exercise intolerant muscle atrophy crepitus and pain reducted ROM |
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what are the standard radiograph views for hip dysplasia? |
VD extended lateral |
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what is the norberg angle? |
gives objective measure of coxofemoral subluxation normal= 105 angle increases as femoral head subluxates |
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secondary radiographic changes? |
new bone deposition around neck and in n around acetabular fossa joint remodelling severity of radiogrpah and clinical signs poorly correlated |
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what are the treatment options for hip subluxation in skeletally immature animals? |
conservative as clin signs improve after growth- weight control, exercise regulation and analgesia. surgery- triple pelvic osteotomy |
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describe triple pelvic osteotomy procedure |
3 osteotomies isolate acetabulum
acetabulum rotated laterally to increase femoral head cover aim to improve joint congruity to slow/ halter progress of OA |
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what are treatment options for hip subluxation in skeletally mature animals? |
conservative surgery- FHNE total hip arthroplasty |
