Hello Scottedwards2000,
There is very little free online literature found on this exact
topic. From what I found, it appears that surgery has a better outcome
if performed as soon after the injury as possible. The few examples I
was able to locate show that some dogs had a good outcome 24-48 hours
after trauma, although the surgery can be performed as late as 3-4
days. Waiting 4-7 days makes complete reduction difficult to
impossible. Recovery in the case histories seemed to be complete by
4-8 weeks,
?Craniodorsal hip luxation with an associated saggital fracture
through the femoral head usually occurs in mature dogs because in the
immature dog the proximal femoral growthplate is the weak link. The
two common causes of craniodorsal hip luxation are either a car
accident or a fall from height (Wadsworth 1993). If the dog is hit by
a car from behind, the animal starts to fall toward the hip to be
luxated and the rear leg on this side moves into
adduction.?
?Craniodorsal hip luxation with an associated saggital fracture
through the femoral head should be treated by open reduction. Closed
reduction is not indicated because of the risk of reluxation of the
femoral head and the likelihood of developing degenerative joint
disease secondary to the damage caused to the articular cartilage and
the irritation from the intraarticular fragment.?
Of the two dogs in this example, one was operated on 24 hours after an
accident, and another 48 hours after a trauma.
?The patient was operated on 24 hours following the trauma?
? Surgery was delayed for 48 hours so that the patient could be stabilized.?
?There were no complications with wound healing. The first dog showed
no lameness 6 weeks after surgery and was allowed to gradually return
to a normal physical activity 2 months after surgery. In the second
patient with the more complex injuries, there was no evidence of
lameness 5 weeks after surgery in
the left hind leg and full function was restored to the right hind leg
8 weeks after surgery.?
http://www.vfu.cz/acta-vet/vol72/pdf/72_261.pdf
?Normally, the dog walked with the operated leg within 3 weeks after
the 2nd surgery. Follow-up radiographs have shown no signs of
degeneration of the femoral head and osteitis at the rim of the
acetabulum.?
?One of the common orthopedic problems in veterinary medicine is a
traumatic luxation of the coxofemoral joint. Open reduction in
treatment for coxofemoral luxation is often necessary because of
chronicity, fractures in the femur or pelvis, or bony fragments or
other debris in the acetabulum, and allows the surgeon to remove
interposed tissues from the acetabulum and to replace the femoral head
under direct observation.
Damage to the femoral head and acetabulum can be assessed and defects
of the acetabular rim can be corrected surgically. In some cases,
suturing the joint capsule and surrounding traumatized tissue may be
effective in retaining the reduction. When closed reduction fails,
open reduction, capsulorrhaphy, and bandaging may be all that is
required to maintain the reduced coxofemoral joint, especially in dogs
with unilateral coxofemoral luxation and no other orthopedic
injuries7.?
?Minimal complications were associated with the use of a toggle pin,
and the reported failure rate was no worse than that for other
surgical procedures for coxofemoral repair3. But, we could believe
that the combination of the toggle pinning and synthetic capsule
technique is more sufficient than toggle pinning alone to prevent
coxofemoral joint from recurrent luxation during early weightbearing,
regardless of the intraoperative integrity of the repaired joint
capsule.?
http://www.ksvc.or.kr/journal/issues/17-1/1719-e.pdf
??approximately 50% of animals presenting with pelvic fractures
require some form of internal reduction and fixation. The intent of
surgery is to provide for a more anatomical result, better function,
more comfort during the period of healing, and, hopefully, a more
rapid union. In the breeding bitch, open reduction resulting in an
anatomically perfect pelvic canal is more likely to allow for normal
delivery of pups. Despite perfect reduction, occasionally
proliferative callus may prevent normal delivery and necessitate
caesarean section.
Open reduction of pelvic fractures should be accomplished as soon as
possible following the animal's positive assessment as a surgical
candidate. Reduction accomplished 24 to 48 hours following the
fracture is much simpler than surgery after 3 to 4 days. By the fourth
to seventh day, postfracture reduction is much more difficult and
complete reduction may be impossible.?
?When an animal's general condition does not allow surgery before 7 to
14 days post fracture, the surgery is best not performed. Usually
after 7 to 14 days of immobilization, the fragments cannot be moved
and union is proceeding rapidly. While radiographically the pelvis
will look unreduced and the end result may lack full normal function,
the result will be adequate. Methods of fixation in open repair of the
pelvis include intramedullary pins, pins and wires, orthopaedic wire,
bone screws, bone plates, and Kirschner wires. Plate and screw
fixation is very stable and more suitable for ilial fractures and
acetabular fractures. Pin, pin and wire, orthopaedic wire, and
Kirschner wire techniques are applicable in any part of the pelvis.?
http://www.ivis.org/special_books/ortho/chapter_27/27mast.asp#g
?Acetabular fractures can have a very good prognosis if reduction and
fixation are anatomical. Results with less than adequate reduction or
fixation can vary from good to poor. Severe degenerative arthritis and
limb dysfunction are included in the latter category.?
?COMPLICATIONS
Most complications accompanying pelvic fractures relate to soft
tissues in the vicinity. Problems with associated nervous, vascular,
bowel, or urethral structures are more common than primary bone
problems. Most of these problems occur as a result of the fracture,
not as a result of poor fixation; therefore, they must be properly
evaluated in the preoperative patient.
A common complication of acetabular fracture is mild to moderate
degenerative joint disease. It must be anticipated. Medical management
of this problem is usually gratifying.
Pelvic fractures that eventually unite in severely abnormal positions
may seriously compromise the pelvic inlet or outlet, resulting in
difficulty in defecating or undergoing normal parturition. This
problem is more commonly associated with feline pelvic fractures. If
surgical correction is required, symphysectomy is necessary, using an
insert to enlarge the diameter of the pelvic canal. Good results have
been reported using this technique (22,29)?
http://www.ivis.org/special_books/ortho/chapter_27/27mast.asp#b
?Fractures of the pelvis comprise about 25% of all fractures
associated with vehicular trauma. Of these, the frequency of which 13%
to 43% are reported to involve the acetabulum. The best outcome for
any fracture involving the acetabulum (or any articular fracture)
requires open reduction and internal fixation with meticulous anatomic
reduction to promote early return to function and decrease the
severity of osteoarthritis. Acetabular fractures are classified as
cranial, caudal, central, or comminuted. Physical and radiographic
evaluation for shock, concomitant fractures, thoracic and abdominal
trauma, blood loss and spinal injury should be performed upon
presentation and treated, (when apparent) prior to considering
anesthesia and surgical repair of the fractures. Surgical repair of
these fractures can be difficult, and many surgeons treat them
conservatively. Conservative treatment and surgical approach,
techniques, complications and aftercare are described.? The entire
article may be purchased for $3.95
http://www.iknowledgenow.com/search.cfm?keywordlist=Acetabulum
?A surgical technique is described for transposition of the
sacrotuberous ligament to replace the teres ligament in the treatment
of coxofemoral luxation in dogs. Ten dogs with coxofemoral luxation
were treated using this technique and all animals regained full limb
function within two months of surgery. It is suggested that the
technique could be employed in dogs suffering from all types of hip
luxations.? The entire article can be purchased for $19.20
http://www.ingentaconnect.com/content/bva/jsap/2002/00000043/00000008/art00002
?Dog 1 was referred for lameness examination following a MVA 2 weeks
previously and exhibited a crouched stance and stilted hindlimb gait,
while dogs 2 to 5 were referred following reluxation subsequent to
closed reduction. In all cases, preoperative radiographic examination
included films obtained following closed reduction to confirm that the
femoral head was well-seated in the acetabulum, as coagulum,
granulation or fibrosis may reduce effective acetabular depth and
preclude anatomic reduction (Figures 1 and 2). All dogs were
candidates for surgical correction of hip luxation.?
http://www.ava.com.au/avj/0008/0008.pdf
?Important factors in the treatment of coxofemoral luxation are early
reduction and prevention of reluxation until the repair of the joint
capsule. A number of techniques for open reduction have been described
for the stabilisation of the hip. However, their application to very
small dogs and cats is often unsatisfactory because of difficulties in
installing screws or wires, and because of the large surgical wound
through the dorsal approach. In order to resolve these problems, the
authors attempted a method of open reduction applicable to very small
dogs and cats. In this method a fine and strong stainless steel rope
was used as a temporary artificial ligament during the repair of the
joint capsule through the ventral approach.?
?Thirty-two dogs successfully recovered and five dogs suffered a reluxation.
The recovered dogs and cats started walking with a slightly stiff gait
within several days after surgery and regained their normal gait after
the spontaneous breaking of the rope between 3 weeks and 4 months.
Postoperative radiographs showed that the reaction of the bones was
negligible in most cases (Figure 3). In a few cases, proliferation of
the bone was observed at the femoral head, but it is unknown whether
this was caused by joint damage resulting from luxation or by the
surgical procedure. One patient, a Maltese dog, had a gait that was
quite normal 3 years after surgery. In addition, deformation and
inflammation of the bone were not observed in radio-graphical and
autopsy findings.?
?Open reductions with postoperative fixation are recommended for
recurrent luxation. According to several reports,1-3 the failure rate
following a single closed reduction is high (50 to 60%). Furthermore,
the success rate of open reduction has been low for animals that have
undergone repeated closed reduction and reluxation, if the aim of the
treatment was to regain smooth motion of the affected legs. Therefore,
open reduction should be done even for acute and simple luxation in
its early stage.
?A number of open reductions have been described for canine
coxofemoral luxation.These include capsulorraphy with trochanteric
transposition,4,5 placement of a prosthesis for the ligament of the
femoral head,6-10 extension of the acetabular rim with bone grafts or
implants,11-15 transverse pinning of the femur to the pelvis either
through the acetabulum16-18 or above it,19 placement of a longitudinal
pin over the joint,20,21 purse- string sutures,22,23 augmentation of
capsulorraphy with auto-genous soft tissues24 and extracapsular suture
techniques.25-28?
http://www.ava.com.au/avj/dec96/460.htm
?The literature contains many open reduction procedures for reducing
and stabilizing hip luxations.(8,10,17,21) Some hip dislocations can
be reduced only through open reduction. Other luxations that can be
reduced often need additional stability, which can be achieved through
one of the open reduction techniques with a concurrent stabilization
procedure. The majority of cranial dorsal dislocations of the hip
involving normal acetabula and femoral heads that are treated through
open reduction can be dealt with adequately by closing the joint
capsule, if present, with simple interrupted sutures and placing the
animal in an Ehmer sling following surgery. With this procedure, a
cranial approach is made to the hip joint and the acetabulum is
debrided. Following reduction of the hip, the joint capsule is sewn
together and the wound closed routinely. Sometimes the joint capsule
may not be present, such as after a prolonged luxation in which the
joint capsule has been worn away. In these cases, other forms of
internal fixation or stabilization must be used to provide fixation.?
http://cal.vet.upenn.edu/saortho/chapter_28/28mast.htm
?Open reduction and internal fixation remains a controversial method
of treatment for these fractures. Few investigators have advocated
humeral head replacement to treat three-part fractures of the proximal
part of the humerus except in elderly patients with comminuted,
osteoporotic bone as a salvage procedure4. Even then, the rationale
for this treatment is usually its ability to provide secure fixation
and simplified rehabilitation, not as a method of preventing avascular
necrosis. Furthermore, the category of "valgus-impacted" four-part
fractures has been better defined as a subgroup that is amenable to
fixation without replacement5. These fractures generally have some
medial soft-tissue attachment and thus are not "classic" four-part
fracture-dislocations. Indeed, this type of fracture may be thought of
as a forme fruste of the four-part fracture-dislocation with lateral
displacement6. In any event, the evolving treatment for these
fractures is percutaneous reduction and fixation7 rather than open
reduction and internal fixation.?
http://www.jbjs.org/Comments/2002/c_p_flatow.shtml
Illustrations:
?FIG. 27-4 (A) Ventral-dorsal radiograph of a dog pelvis demonstrates
bilateral sacroiliac separation, a right caudal acetabular fracture,
and left hip luxation and subtrochanteric femoral fracture. (B)
Radiograph demonstrates the result of reduction and fixation of the
right sacroiliac separation using two interfragmentary screws.?
http://www.ivis.org/special_books/ortho/chapter_27/27mast.asp#b
If this is not the answer you were seeking, please do not close this
question by rating, until you have requested an Answer Clarification.
This will allow me to assist you further. Keep in mind the outcome of
the surgery depends on the nature of the injury and the age and
condition of the dog.
I wish your dog the best!
Sincerely, Crabcakes
Search Terms
=============
Dislocated or luxation + open reduction + canine
open reduction + canine + hip luxation ?dysplasia
open reduction hip surgery + canines
open reduction + canine + hip luxation or dislocation |
Clarification of Answer by
crabcakes-ga
on
26 Sep 2005 13:52 PDT
Hello again,
"The second category is the subluxation of the hip in which the
femoral head prefers to reside in the acetabulum but a lateral
translation routinely occurs. This is an ideal case for a Femoral
Neck Lengthening procedure and/or 20 degree Pelvic Osteotomy procedure
or Minor DARthroplasty procedure. Normal function can be expected to
return."
http://www.slocumenterprises.com/Articles/canine_hip_classification.htm
http://www.slocumenterprises.com/Articles/angle_of_subluxation_reduction.htm
"Not all dogs do well following FHO surgery and it should be
considered a clear second choice. FHO is an alternative surgery to the
expensive total hip replacement surgery. While there is significant
potential for long-term complications, FHO should be carefully
considered within its narrow recommended parameters. A prolonged
recovery, muscle atrophy and ?bed sore? type ulcers are frequent
problems associated with this procedure. In this procedure the bone is
shortened, therefore the gait will be affected. The biceps sling can
cause a slight adduction (drawing in toward the centerline) of the
affected limb during exercise. Obese or very large dogs will
experience some pain, as the muscles cannot totally compensate. On the
positive side, this procedure has worked well over the years. The dog
is pain free afterwards and learns to walk again, but running and
jumping are not done normally again. It is radical and invasive
surgery, but under the right circumstances has produced very
acceptable results."
http://www.geocities.com/schlosser44/CHD.html#surgery
"The third surgical option for hip dysplasia is a salvage procedure
known as the femoral head and neck excision or ostectomy (FHO).
Referred to as a salvage procedure, once this is performed, no other
procedure can be done on that same joint. This surgery involves
cutting the femoral head and neck off of the femur and removing it.
This leaves the dog with a false joint of ligaments, muscle and joint
capsule since the ball part of the joint has been removed. Most of the
time this surgery is reserved for dogs with severe arthritic changes
in their hips or for younger dogs with very unstable or luxating hips.
Usually, smaller dogs do better with an FHO but larger dogs can also
have good success with it. This surgery is more widely available and
is usually the least expensive of the three surgeries but varies from
Veterinarian to Veterinarian."
http://www.adoptagolden.com/k9stuff/vetcorner/hipsur.htm
"You don't say how large your dog is, but that has some bearing on the
outcome of the surgery you describe, a femoral head ostectomy. In this
surgery, the ball portion of the hip joint (the femoral head) is
removed and the bone smoothed, if necessary, so that no bone to bone
contact occurs between the pelvis, which contains the now empty socket
and the remaining portion of the femur. The joint is not stablized, it
is destroyed. While that sounds bad, in almost all dogs under 40 to 50
lbs in weight, this surgery will provide reasonable comfort. A "false
joint" forms, consisting of fibrous scar tissue around the bone end.
This forms in the muscles over the hip, which fortunately are strong
enough to provide some stability. It is less painful than leaving the
dislocated femoral head rubbing against the pelvic bone.
The shoulder joint is naturally constructed in a similar fashion,
although it has more stabilization. In dogs over 50 pounds of body
weight there is more concern that the joint will not be functional due
to the need for more weight bearing capacity. Most of the time, there
is still reasonable comfort even in big dogs but the outcome is more
questionable in these dogs.
There are alternatives.
1) Stabilization of the joint can be attempted. Many vets are
reluctant to do these surgeries because some of them are technically
difficult and all of them have a moderate failure rate. It is
disconcerting to do surgery, collect a large fee, have to explain the
failure to the client and then have to go back and do a femoral head
ostectomy anyway. There are several possible stabilization procedures,
including pinning the femoral head to the hip socket, moving the
portion of the bone where muscle attachment occurs to a different site
on the femur to provide more stability, toggle pinning the femoral
head and several other stabilization techniques. It may be necessary
to ask for referral to a surgical specialist for these procedures as
many general practitioners are not comfortable doing them.
2) Total hip replacement. This is an option in some cases when hips
can not be stabilized but it is necessary to consider this on a case
by case basis. Again, this surgery requires referral to a surgical
specialist in most cases. Very few veterinary practices have the
capability of doing hip replacement surgery.
If an alternative stabilization technique doesn't work, femoral head
ostectomy remains an option. You do end up paying for two surgeries
when one of the other stabilization methods fail but if they work, the
outcome is better for your dog. I am sorry, but I do not know what the
success rates of the various surgeries would be as it depends a lot on
the individual surgeon's experience and skill.
Mike Richards, DVM "
http://www.vetinfo4dogs.com/dhipsurgery.html#Hip%20repair%20-%20femoral%20head%20ostectomy
"Usually, the first approach is a closed reduction with the
application of an Ehmer or non-weight bearing sling. If this fails,
then the options are: 1] Closed reduction and instillation of a Devita
Pin, 2] Open reduction and internal stabilization, 3] Femoral head and
neck excision arthroplasty [FHO], 4] Triple Pelvic Osteotomy [TPO],
and Total Hip Replacement [THR]."
http://petsurgeonla.com/nfaq.html
"Hip dislocation (also called coxofemoral luxation) is most common in
dogs following some sort of trauma, such as being hit by a car, or
falling from a significant distance. What happens is the ligaments and
tissue surrounding the hip joint that normally help keep the head of
the femur inside the "cup" (also called acetabulum) or the hip bones,
stretch and or tear.
There are 2 general types of treatment for hip luxations - closed
reduction and open reduction. Closed reduction means no surgery is
necessary. The joint is forced back into the normal configuration
using a combination of force, and in some cases, external pinning.
Open reduction means surgically fixing the joint. Usually open
reduction is necessary if there are complicating factors such as
fractures in the bones that make up the joint, if the joint keeps
luxating even after closed reduction, or if the joint has been out for
a long time."
http://www.community.skylos.com/component/option,com_simpleboard/Itemid,59/func,view/id,295/catid,4/
"This surgery is called femoral head arthroplasty, ostectomy or
femoral head excision. Over my career, the majority of these cases
have been in pets that had their natural joint destroyed by automobile
accidents. In these cases, failure to re-align the joint promptly
resulted in a ?trick? or painful joint. Other reasons for performing
this surgery include a chronically luxating (separated or loose) joint
due to hip dysplasia, arthritis of the hip, aseptic femoral head
necrosis (Legg Perthe?s Disease or ?dissolving femoral head?), and
accidental fractures of the femoral head and neck. The head of the
femur receives all of its blood and nutrients through the femoral neck
so femoral neck fractures repaired with screws and pins only succeed
in about half the cases. In the other half, arthritis and a painful
hip result. In these unsuccessful cases, femoral head excision usually
allows the pet to regain excellent use of the leg."
http://www.2ndchance.info/hipsurgery.htm
"After surgery, the animal maintains its knee slightly straighter to
compensate for the slight shortening of the femur. For the first 4
weeks after surgery I confine the pet to a small cage and have the
owner frequently massage the muscles of the leg. By the fifths or
sixth week after surgery I encourage as much light activity as
possible to prevent further atrophy (withering) of the muscles of the
leg. I have the owners passively flex and extend the leg and continue
massages four times a day. Dogs and cats do quite well on three legs
so it is difficult to start them using the repaired leg. Sometimes I
resort to taping a sock onto their good rear leg to encourage them to
use the newly reconstructed joint. I have also found that swimming
really hastens recovery and use of the affected leg. Within six months
of surgery almost all dogs lope about as if nothing had happened. I
love to do this surgery because it is one of the most successful,
heartening and emotionally rewarding procedures I perform."
http://www.2ndchance.info/hipsurgery.htm
I'm wondering is a total hip replacement has been considered for your dog?
"Both the ball (head of the femur) and socket (acetabulum) of the hip
joint are replaced with prosthetic implants. The new ball is made from
a cobalt-chromium metal alloy and the new socket from high-density
polyethylene plastic. Special bone cement is used to hold these
implants in place."
"In reviewing the records of patients that have had THR, a little over
95% of dogs have had good to excellent function with this procedure.
These patients have pain-free function, increased muscle mass, no
limping, and increased activity."
http://www.cah.com/dr_library/sxdysp.html
http://dogs.about.com/cs/disableddogs/a/chd_surgery.htm
"Over my career, the majority of these cases have been in pets that
had their natural joint destroyed by automobile accidents. In these
cases, failure to re-align the joint promptly resulted in a ?trick? or
painful joint. Other reasons for performing this surgery include a
chronically luxating (separated or loose) joint due to hip dysplasia,
arthritis of the hip, aseptic femoral head necrosis (Legg Perthe?s
Disease or ?dissolving femoral head?), and accidental fractures of the
femoral head and neck. The head of the femur receives all of its blood
and nutrients through the femoral neck so femoral neck fractures
repaired with screws and pins only succeed in about half the cases. In
the other half, arthritis and a painful hip result. In these
unsuccessful cases, femoral head excision usually allows the pet to
regain excellent use of the leg."
"In performing this surgery, I incise and peal back the skin of the
hip for good visualization of the muscles, ligaments and bone that
form the joint. In preparation for the procedure, I locate and mark a
large nerve (the sciatic nerve) that runs just posterior to the joint
so that I do not injure it. I remove the diseased femoral head with a
plier-like tool called rongeurs and file the bone smooth. I relocate
surrounding muscle and cartilage as padding between the ends of the
bone and then I place several harnesses of stainless steel drilled
through the hump (protuberance) on the femur called the greater
trochanter. Using suture material and nylon cord that lasts for the
rest of the pet?s life, I construct a synthetic joint."
"It is amazing how well the body adapts to this surgery. The biggest
problem is that results do not tend to be as good when a dog weighs
over forty pounds"
http://www.men.com/yourlife/pets/331
I'm afraid I have found only this additional information on luxation
of canine hips, and NOT including dysplasia!
I certainly hope this has helped you!
Sincerely, Crabcakes
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