trochanter of femur until exposure of the femur head and acetabulum: -manual reduction or. -Femur head Ostectomy (false joint formation). -Toggle pin fixation or ...
Pelvis and Hip Injuries
By El-Sayed El-Shafaey (BVMS, MVMS & Ph.D) Assistant Professor of Surgery, Anesthesia & Radiology Faculty of Veterinary Medicine - Mansoura University
Objectives
Surgical anatomy of the pelvis and hip in animals.
Common injuries of the pelvis and hip in animals.
Economic importance of the pelvis and hip injuries.
Definitive diagnosis of the pelvis and hip injuries.
Prognosis & decision of the pelvis and hip injuries.
Treatment of the pelvis and hip injuries.
I- Anatomy of the Pelvis and Hip
II- Injuries of the Pelvis and Hip
A- Pelvis Injuries:
1- Pelvic fractures
B- Hip injuries:
1- Coxitis
2- Hip dislocation
3- Fractures
4- Hip dysplasia
III- Economic importance
Pelvic and hip injuries involve farm animals, athletics and pets especially older ones.
Most of the pelvis injuries are of traumatic origin.
Definitive diagnosis is the aim of treatment of pelvic and hip injuries.
Pelvic and hip injuries are potentially life threatening injuries induce great losses in productivity and performance of affected animals.
Causes -Traumatic : 1-Falling 2-Slipping 3-Fighting 4-Accidents with cars Incidence: common in cattle than equines. Clinical signs 1-Severe lameness and pain. 2-Pelvic asymmetry (hip hike). 3-Crepitation on manipulation of the pelvis. 4- General signs of fracture. 5-Muscle atrophy in chronic cases.
Diagnosis: -Diagnosis of pelvic fractures challenge in practice. I-Case history: -The history of a sudden onset of the lameness is usually a clear indication of a traumatic event. II-Clinical Examination 1- Visual examinations: A- Rest: ♦Symmetry of the hindquarters. ♦Pelvic height. ♦ Limb length.
♦ limb position: a- Limb deformity (shortening, lengthen, outward & inward directed). b-Toe-out, hock-in position is more often found with: -pelvic fractures. B- Walking:
-Significant lameness, depending on the duration of the fracture.
2-Palpation: ♦Lumbar and pelvic muscles to identify: -Abnormal muscle tension -Pain -Swelling or hematoma. ♦Bony prominences (tubers) to identify pain or defensive reactions. -Keeping hand contact on these prominences during horse walking for detecting: -Crepitation (Manual or by Auscultation) -Abnormal motion or asymmetry of the pelvic region.
III-Rectal examination: for -The aorta and iliac arteries -The psoas muscles -The caudal aspect of the iliac shaft, pubis, and ischium.
Hip clamp
IV-Diagnostic imaging: 1-Radiography 2-Ultrasonography 3-Nuclear scintigraphy. V-Differential diagnosis: between 1- Different types of pelvic fractures. 2- Hip dislocation 3- Hip fractures Prognosis: -Favorable.
-Guarded.
-Bad.
Treatment: On-site Management 1-conservative -Strict stall rest for at least 60 days is most important. 2-anti-inflammatory medication (NSAIDs). 3-Specific treatment according to the type and site of fracture.
Different types of pelvic fractures Tuber coxae fracture Incidence
Iliac wing fracture
More common in cattle than equines and small animals?
Causes Symptoms Diagnosis Prognosis Treatment
Iliac shaft fracture
Pelvic floor fracture Rare?
Traumatic Not affect the mechanical movement of the limb.
2- Injuries of the Hip 1-Coxitis 2-Dislocation 3-Fracture 4-Dysplasia
5- Round ligament fracture
1- Coxitis (Hip arthritis) Definition -Inflammation of the hip (coxofemoral) joint.
Incidence -High in cattle and donkeys?
Causes 1-Trauma 2-Ascending infection 3-Complication of fracture (femur or acetabulum)
Types 1-Acute coxitis 2-Chronic coxitis Symptoms 1-Severe lameness, specially during the forward extension of the limb. 2-Limb circumduction? -Stifle and toe outside/ Hock inside 3-Difficult movement with short steps)stiffness) 4-Extension of the hindlimb joints 5-Swelling with pain of the hip region 6-Musclar atrophy in chronic cases
Prognosis: depends on the cause 1- Trauma: guarded 2- Chronic infection specially in old and heavy animals: bad Treatment -Most cases referred to you after chronicity? 1-Blistering: -iodine/camphor ointment 2-Needle point firing specially in large animals 3-Seton of the hip region 4-Rest of the animal 5-Antibiotic to guard against infection 6-Antitetanic serum 7-Intraarticular injection of corticosteroids in small animals
2- Hip dislocation/displacement/ Coxofemoral luxation/subluxation Definition Partial or total displacement of the femur head from the acetabulum.
Causes 1-Severe trauma: -Slippery -Over physiological limit step 2-Congenital anomalies -Large femur head -Absence of round ligament 3-Diseases: Chronic/Metabolic (hypocalcaemia) Classification 1-According to the limb -Unilateral -Bilateral
2- According to the degree -Partial -Total 3- According to the direction -Anterior (cranial) -Posterior (caudal) -Superior/dorsal(75%) -Inferior (ventral) N.B. Dorsocrainial is the most common form of dislocation. Symptoms 1-Sudden onset of severe lameness with difficult movement 2-Swelling of the hip region (Asymmetry of the hip) 3-Deformities of the limb: -Easily rotated (outward) -Shortening (just touch the ground):Anterior form -Lengthening (rest on the ground):Posterior form
-Stifle and toe outside/ Hock inside. 4-Extension of all the hindlimb joints 5-Stiffnes and circumduction of the affected limb. 6-Cripitation (click) sound during movement? 7-Dragging of the affected limb straight out behind the sound limb. 8-In bilateral forms, the cow be recumbent. 9-Temporary or permanent sciatic nerve paralysis; if injured.
Stifle and toe outside/ Hock inside
Diagnosis: 1-Leg manipulation externally and rectally. -Crepitation sound by manual or stethoscope 2-Rectal palpation: superior form interfere with the obturator foramen 3-Surface palpation 4-Radiograph 5-Differential diagnosis: a-Pelvic fracture b-Femur head fracture c-Rupture of the round ligament
Prognosis:
depends on: -The age and weight of the animal: -Small and light weight animal: good
-Large and heavy weight animal: guarded to unfavorable? -In bilateral forms: the prognosis will be extremely poor?
Treatment 1-Reduction (within 48 hours?) A-Closed reduction (Extension & counter extension):rarely successful except in young age? -Up to 25% of hips that are successfully replaced will reluxate. -Hobbling the feet together for 10–14 days after replacement may reduce the incidence of this occurring.
B-Open reduction -Under general or epidural anesthesia -Lateral recumbency -A 20-25 cm incision anterior to the great trochanter of femur until exposure of the femur head and acetabulum: -manual reduction or -Femur head Ostectomy (false joint formation) -Toggle pin fixation or intraarticular pinning -Wound closure
2-Fixation -Injection of irritant material around the hip joint? -External coaptation -Complete rest of the animal for 6-8 weeks then mild exercise -Treatment of metabolic deficiency N.B. The success rate for repair of coxofemoral luxation is around 75% for craniodorsal and 30% for ventral forms. -Chronic cases develop a pseudoarthrosis, but continuing severe lameness and weight loss can be expected.
3- Fracture of the femur Causes 1-Traumatic:Accident/falling down/kicking 2- Metabolic: Osteoporosis Incidence -Large animals: rare except in neonatal calves -Small animals: very common specially in dogs Symptoms: Prognosis: depends on the animal and site -L.A: usually diaphyseal fracture: bad? -S.A: usually metaphyseal fracture: good
Treatment 1-Large animals -Slaughtering or euthanasia -Valuable breeds: internal fixation by double pinning: intramedullary and extra medullary fixation 2-Small animals -External fixation: Thomas splint / cast -Intramedullary bone pinning -Bone plating -Femoral head Ostectomy (pseudoarthrosis)
4- Hip Dysplasia in dogs and cats Definition: Chronic degenerative joint disease of dogs and cats characterized by abnormal development or growth of the hip joint. -Is the most common cause of hindlimb lameness in dogs and usually occurring bilaterally. Causes: Multifactorial 1-Genetic 2-Environmental (diet/exercise)
Incidence: -Common in German shepherd, Labrador and retrievers. - Affect puppies from 4 - 12month and adult dogs above 15 months.
What Hip Dysplasia Looks Like? 1-Increasing the joint space. Normal Hip Joint
2-Increasing the joint wear. Hip Dysplasia Joint
Signs of Hip Dysplasia 1. Back legs sliding (frog leg/ forward drawing of hindlimbs). 2. A dog standing with hind legs close together.
3. Trouble Getting up (Walk, Lay down)
(Bunny hopping, stiffness on rising after a rest) 4. Exercise intolerance. 5. Hip pain with a swaying/ awkward gait (limping).
6. Atrophy of thigh muscle in chronic cases (2 years).
Complications of Hip Dysplasia 1. Weakness in the hind quarters (laxity & instability). 2. Malformation of femur head and acetabulum(subluxation).
3. Gait abnormalities. 4. Lameness in the hind quarters. 5. Complementary lameness in the other leg (Anterior Cruciate Rupture). 6. Arthritis
7. Osteoarthrosis
Diagnosis 1-Radiographic examinations: Dorsal recumbency -Essential in establishing a positive diagnosis of hip dysplasia (May be radiologically abnormal but show no clinical signs). Dysplastic animals fall into the following three categories: 1. Mild: -Minimal deviation from normal. -Slight flattening of the femoral head and minor subluxation. 2. Moderate:-Obvious deviation from normal -Flattened femoral head. -subluxation with marked changes of the femoral head and neck. 3. Severe: -Complete dislocation of the hip -Severe flattening of the acetabulum and femoral head.
Normal Hip
Severe Hip Dysplasia
2-Physical Examinations 1-Palpation of the femur head and hip laxity is somewhat painful in the young adult. 2-In the older dog, listening for crepitus with the examiner’s ear or stethoscope. - Ortolani sign (the surgeon feel the hip crisply pop in and out of the joint)
Treatment 1-Conservative Therapy: -Decrease exercise -Decrease body weight -Analgesic and anti-inflammatory drugs
2-Surgical therapy
Femoral Head Ostectomy (FHO) - removing head of femur, false joint. Triple Pelvic Ostectomy (TPO) - pelvis cut and rotated for tighter fit. Total Hip Replacement (THR) - replaces head of femur, adult dogs under 40lb only.
-The objective of this procedure is to replace the cartilage of the acetabulum “socket” with a polyethylene socket, and the femoral head with a metal prosthesis (indicated in DJD).
FHO
TPO
THR
After Surgery Treatments Exercise: -Treadmill (swimming) in water, helping the “new” hip
