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VMS4001 SEM 2 > Sx of the Hip and Pelvis > Flashcards

Sx of the Hip and Pelvis Flashcards

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1
Q

History of pelvic fracture?

A

Often Traumatic -> likely other organ assessment before repair of fracture
- stabilise & treat shock & provide pain releif with full mu agonist opioid

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2
Q

What emergency diagnositcs might you do in this case?

A
  • thoracic FAST scan
  • Abdo Fast scan -> diaphragm or bladder ruputure?
  • Haem/ electrolytes & biochem
  • PCV/ tp - thoracic Xrays
  • Abdo imaging -> pos contrast urethrogram
  • Rectal exam -> blood-> rectal perf
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3
Q

What are soem concomitant injuries of pelvic fractures?

A
  • Pulm trauma
  • Cardiac arrythmias
  • Haemoabdomen
  • UT injury
  • spinal trauma
  • Septic peritonitis
  • Wounds
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4
Q

How long can you safely wait to solve pelvic fract?

A

7-10 days

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5
Q

Ortho exam?

A

palpate landmarks -> ilial wing, tuber ischii, greater trochanter

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6
Q

Neuro assessment of HLs?

A

evaluate voluntary movement,
proprioception, withdrawal reflexes,
perineal reflex, anal tone, tail
movement and sensation, deep pain (if
no voluntary movement)

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7
Q

Pelvic imaging?

A

ONCE STABLE -> fullf ract assessment -> two orthogonal views of pelvis under deep sedation or GA

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8
Q

What categories of pelvic fractures do we have?

A
  1. Sacroiliac
    fracture/luxation
  2. Iliac wing fracture
  3. Iliac body fracture
  4. Acetabular fracture
  5. Ischial fracture
  6. Pelvic floor fracture
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9
Q

When are they surgical candidates?

A
  • Fractures which narrow the pelvic canal
    (Constipation/obstipation ++ cats)
  • Preservation and protection of essential
    neurovascular structures (sciatic nerve
    entrapment → intractable pain)
  • Contralateral fractures/bilateral
    sacroiliac luxation/multiple comminuted
    fractures
  • Fractures in working dogs
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10
Q

Which exact locations would we want to repair?

A

Fractures of the acetabulum, ilial body
and fracture-separations of the sacroiliac
joint (load bearing axis) → repaired to
restore early weight bearing, avoid issues
of malalignment of the hip joint
(acetabular fractures), pelvic malunion,
minimise traumatic arthritis →
osteoarthritis?

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11
Q

Which fractures theoretically don’t need surgery?

A
  • Iliac wing, pubic and ischial fractures are
    not on the load bearing axis
    EXCEPTIONS:
  • Significant dispalced/ unstable ischial fractures
  • Pubic fractures if ventral abdo wall herniation
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12
Q

What factors to take into account with decision making?

A
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13
Q

What indications for conservative management?

A
  • Minimally displaced ilial fractures
  • Minimally displaced pubic fractures
  • Minimally displaced ischial fractures
  • Minimally displaced sacroiliac
    luxation
  • Fractures > 2weeks old (worse
    prognosis)
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14
Q

What is conservative management for these?

A
  • Cage rest, but allow to stand and move around inside the cage
  • Well-padded kennel (to avoid decubital ulcers)
  • Low sided litter tray
  • Many patients are able to stand and move around in 1 or 2 days
  • Cage rest for 6-8 weeks until radiographs are repeated
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15
Q

How to repair Sacriiliac fract/ lux?

A
  • Get a screw ideally > 60% sacral width
  • Dorsal aspect approach
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16
Q

Approach to ilial body fract?

A

Lateral incision approach

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17
Q

Approach to acetabulum fract?

A

Craniodorsal and caudodorsal aspects of hip

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18
Q

Describe anatomy of the coxofemoral joint?

A

Primary Hip Stabilisers
* Ligament of the femoral head
* Joint capsule
* Dorsal acetabular rim

Secondary Hip Stabilisers
* Acetabular labrum
* Hydrostatic pressure
* Periarticular muscles

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19
Q

Describe coxofemoral luxation?

A
  • 90% of all joint luxations in dogs and
    cats
  • Vehicular trauma is the cause of up
    to 85% of these luxations →
    emergency management!!!
  • Animals with hip dysplasia are
    predisposed
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20
Q

Describe Coxofemoral luxation?

A
  • Most common type of
    coxofemoral luxation
  • Non-weight bearing lameness
    (limb is shorter)→ affected limb
    externally rotated and adducted
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21
Q

On palpation of craniodorsal luxation?

A

→ the greater trochanter is elevated in
comparison to the normal side and the space between the GT and the ischiatic tuberosity is increased

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22
Q

Describe Closed reduction of coxofemoral luxation - wehn to do it?

A
  • Acute luxation < 24h
  • Do not attempt in luxation > 7 days
    duration
  • Do not attempt if fracture, severe
    hip dysplasia, bad dorsal acetabular
    coverage or avulsion fragment of
    the round ligament of the femoral
    head
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23
Q

What to do after closed recution?

A

Ehmer sling 7-10d

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24
Q

What can we do alongside closed reduction?

A

Ischioillial pinning

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25
Describe objectives of open reduction after the joint is exposed?
* Remove or reduce any soft tissue that may be blocking the acetabulum * Reduce the femoral head into the acetabulum * Stabilise the femoral head in the acetabulum
26
most common techniques for open reduction in luxation case?
* Most common techniques: toggle pin stabilisation and transarticular pinning * Other techniques: Prosthetic capsule technique, extra-articular ilio-femoral suture * Capsulorrhaphy (if possible)
27
TRANSARTICULAR PINNING?
28
Other technique?
29
INDICATIONS for femoral H & N excision (salvage procedure) ?
* Chronic or recurrent coxofemoral luxation * Severe coxofemoral osteoarthritis * Complicated femoral head, neck, or acetabular fractures * Avascular necrosis of the femoral head * Failed total hip replacement * Cats and dogs < 18/20kg
30
Complications of FHNE sx?
* Shortening of the limb * Damage to or entrapment of the sciatic nerve * Muscle atrophy * Decreased range of motion of the hip, particularly on extension * Continued pain, lameness, and reduced exercise tolerance
31
DESCRIBE HIP DYSPLASIA?
* Heritable, polygenic * Phenotypic expression can be influenced by environmental factors
32
Describe PHENOTYPE Hip Dysplasia?
33
Clinical signs of Hip Dysplasia?
* Clinical signs are variable. There is not always a lameness → sometimes clinical signs do not correlate with radiographic changes * Progression can be variable
34
otho exam for hip dysplasia?
* Posture and conformation * Gait → Lameness? * Muscle atrophy * Decrease range of motion of the coxofemoral joint * Crepitus or pain * Under sedation → Laxity (Ortolani test)
35
Ortolani test?
36
Interpretation of Ortolani test?
* First part of the Ortolani test (Barlow test) - causes dorsal subluxation of the femoral head in dogs with hip joint laxity * Second part of the Ortolani test - a click or clunk can be heard and/or palpated as abrupt reduction of the femoral head occurs → interpreted as a positive Ortolani sign and suggests laxity of the hip joint
37
Angle of ortolani test?
* The greater the laxity the greater the probability of developing DJD * Reduction angle – correlates with severity of laxity
38
what is the sensitivity of ortolani test?
* Dogs > 4months 92% - 100% sensitivity * Dogs < 4 months 55% sensitivity
39
What might reduce usefulness of ortolani test?
Coxofemoral remodelling reduces usefulness – false negative
40
Describe a normal hip on radiograph?
Normal hip: * Congruent joint * Acetabular coverage >60% * Distinct cranial effective acetabular margin * Straight or slightly concave dorsal acetabular rim
41
Describe a dysplastic hip on xray?
* Incongruency of cranial acetabular rim and femoral head * Widening or wedging of the cranial third of the joint space * Less than 60% coverage of femoral head by the acetabular rim * Shallow dorsal acetabular rim with osteophytes present * Abnormal conformation of the femoral head
42
Norberg angle?
* Relationship between centre of femoral head and craniolateral aspect of the dorsal acetabular rim * An angle greater than 105 degrees is considered normal
43
Early detection of hip dysplasia?
- Ortolani method? Only reliable at 16 to 18 weeks - BVS assessment method not reliable at 6 to 10 or 16 to 18 weeks better in older animals - Distraction index measurement most predictive in young puppies
44
What does BVs hip scheme look at?
45
CONSERVATIVE MANAGEMENT OF HIP DYSPLASIA?
* Controlled/low impact exercise * Hydrotherapy → under-water treadmill * Physiotherapy * Weight loss * Pain management if needed
46
Surgical procedures that may prevent or limit develoment of hip dx?
* Juvenile pubic symphysiodesis * Triple/double pelvic osteotomy * Intertrochanteric osteotomy
47
Salvage procedures?
* Femoral head and neck excision * Total hip replacement
48
Describe Juvenile pubic symphysiodesos (JPS)
* Improves hip congruity * Produces progressive ventral acetabular rotation: * Better dorsal coverage of the femoral head * Reduces hip laxity over time * May halt progression of degenerative changes
49
When do we do JPS?
12-15 weeks old - neutering at same time - ethically!
50
Describe double or triple pelvic osteotomies?
* Double (DPO) and Triple Pelvic Osteotomies (TPO) are two prophylactic procedures used on immature dogs * Osteotomies of the pelvis allow rotation of the acetabulum and improve coverage of the femoral head
51
When are 2x / 3x osteotomies done? requirements?
* Young dogs <10 months * Requirements: * No signs of DJD * No wear of the dorsal acetabular rim
52
Acetabular rotaiton in triple pelvic osteotomy?
20-30°
53
Decribe double pelvic osteotomy?
* Less morbidity, less surgery time * Less pelvic stenosis * Need for stronger implants
54
What other conditions look like hip dysplasia?
* Lumbosacral disease * Gracillis injury * Bilateral cruciate disease * Different spinal problem…
55
THR ?
-> Replaces entire hip joint * Prosthetic femoral head * Prosthetic acetabular cup -> Cemented and cement-less systems available -> Reserved for clinically affected animals which fail conservative management
56
Hip denervation?
57
Describe slipped capital femoral epiphysis SIGNALMENT in cats?
* Male neutered * Overweight * Younger than 2 years of age * Early spay → delayed physical closure? * Unilateral or bilateral
58
What is involved in slipped capital femoral epiphysis?
* Progressive displacement of the capital femoral epiphysis from the proximal femoral metaphysis through the growth plate * No history of significant trauma * Repair often fails → femoral head and neck excision
59
Avascular necrosis fo the femoral head?
* Legg Calve Perthes * Small and toy breeds * Similar distribution between male and female * Unknown cause * Necrosis, malformation and collapse of the femoral head * Very painful!-> FHNE
60
61
What pen hip measurement is good or bad
If D< 0.30 GOOD If D>0.70 BAD

VMS4001 SEM 2 (28 decks)

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