Femur &hip affections 1

Fractures of the Fractures of the FemurFemur

Fractures of the femur are relatively common in dogs, horses and rarely in cattle.

In young animals, fractures often involve the proximal and distal growth plate, and if the diaphysis is involved, the fracture is usually simple and oblique.

Adults, on the other hand usually sustain comminuted fractures of the femoral shaft.

In either case these femoral shaft fractures are usually severely over-ridden, making it difficult to reduce the fracture at surgery.

Etiology:

Young foals frequent sustain femoral fractures during the initial handling and training.

Occasionally the mare will step on the foal causing this type of injury.

In the mature horse considerable force is required to fracture the femur.

In dogs, trauma or accident are the most common causes of femur fracture.

Jumping from a high place or gunshot wounds are another cause of the fracture.

In cattle, external causes as falling down or internal causes as osteomalacia or in high milking cows, which are pregnant.

Signs:Signs:

Horses with femoral fracture are frequently presented with a history of severe trauma leading to a non-weight-bearing lameness.

When viewed from the side, the affected limb will appear slightly shortened with the hock held higher than the opposite hind limb and a dimpling of the musculature overlying the fracture may be observed.

In younger horses swelling can be observed and crepitation may be apparent.

In many cases of complete fracture of the femur in horses and cattle, the animal is lying and unlike to rise.

DiagnosisDiagnosis::

Although the clinical signs are informative, except for the proximal growth plate fractures, radiographs are important to make a definitive diagnosis.

PrognosisPrognosis::

Favourable in dogs and young large animals; and incurable in large adult owing to large callus is formed which interfere with the proper reduction of the fractured ends.

Therefore, press on the nerves causing permanent lameness.

TreatmentTreatment::Treatment of femoral shaft fractures

is dependent on the age of the animal and the type and location of the fracture.

Generally euthanasia should be performed for adults and yearlings that have sustained femoral shaft fractures.

In young foals, intra-medullary pinning and compression plating with cortical screws are probably the treatment of choice.

The Coxofemoral Joint

Coxofemoral Luxation Coxofemoral Luxation (Luxatio Femoris)(Luxatio Femoris)

(Dislocation of the Hip (Dislocation of the Hip Joint)Joint)

Although dislocation of the hip joint of Although dislocation of the hip joint of horses is not common, when it does occur, horses is not common, when it does occur, young horses and ponies are most young horses and ponies are most frequently affected.frequently affected.

In horses, the ileum tends to fracture In horses, the ileum tends to fracture before dislocation of the hip occurs. before dislocation of the hip occurs.

Therefore, the affection is prevailent in Therefore, the affection is prevailent in cattle and buffaloes but rare in sheep goat cattle and buffaloes but rare in sheep goat and equine. and equine.

EtiologyEtiology::

In most cases trauma is the etiology. In most cases trauma is the etiology.

Violent over-extension and falling on the Violent over-extension and falling on the point of the stifle with the femur in a point of the stifle with the femur in a vertical position occasionally produces vertical position occasionally produces fracture and/or luxation of the coxofemoral fracture and/or luxation of the coxofemoral joint.joint.

Because of the deep acetabulum in the Because of the deep acetabulum in the horse, fractures of the dorsal rim occur horse, fractures of the dorsal rim occur frequently with luxation. frequently with luxation.

Also, abnormalities of the coxofemoral Also, abnormalities of the coxofemoral joint associated with absence or joint associated with absence or tearing of the ligament of the head of tearing of the ligament of the head of the femur or the accessory ligament the femur or the accessory ligament can predispose to subluxation and can predispose to subluxation and luxation with or without associated luxation with or without associated trauma. trauma.

Coxofemoral luxation, are often Coxofemoral luxation, are often complicated by upward patellar complicated by upward patellar fixation.fixation.

SignsSigns::

The femur is usually displaced The femur is usually displaced forward and upward (craniodorsad) forward and upward (craniodorsad) when the hip luxates when the hip luxates (Luxatio (Luxatio Femoris Supraglenoidalis Cranialis)Femoris Supraglenoidalis Cranialis). .

Signs that usually accompany Signs that usually accompany dislocation are limited cranial stride, dislocation are limited cranial stride, because of a pronounced shortening because of a pronounced shortening of the limb, and more prominence of of the limb, and more prominence of the greater trochanter of the femur. the greater trochanter of the femur.

The limb appears to angle somewhat The limb appears to angle somewhat because of shortening. because of shortening.

The toe and stifle turn outward and The toe and stifle turn outward and the hock inward.the hock inward.

The affected limb is positioned The affected limb is positioned behind the sound one or if crossing behind the sound one or if crossing each other, it will also behind. each other, it will also behind.

Soft tissue swelling may make this Soft tissue swelling may make this prominence difficult to determine in prominence difficult to determine in early stages.early stages.

Crepitation of the joint, as a result of Crepitation of the joint, as a result of the femur rubbing on the shaft of the femur rubbing on the shaft of the ilium, may cause one to think the the ilium, may cause one to think the pelvis is fractured. pelvis is fractured.

Rectal examination should be made Rectal examination should be made to eliminate such a possibility.to eliminate such a possibility.

TreatmentTreatment::In animal that have not fractured the In animal that have not fractured the

dorsal rim of the acetabulum, the dorsal rim of the acetabulum, the luxation can be reduced while the luxation can be reduced while the horse is under general anesthesia by horse is under general anesthesia by direct traction and manipulation if direct traction and manipulation if good muscle relaxation is obtained. good muscle relaxation is obtained.

Manipulation of the greater Manipulation of the greater trochanter is often helpful. trochanter is often helpful.

Reduction can be appreciated when Reduction can be appreciated when the hip clicks into place.the hip clicks into place.

A surgical approach can be used in A surgical approach can be used in those cases that can not be reduced those cases that can not be reduced by closed reduction. by closed reduction.

For those cases that continue to re-For those cases that continue to re-luxate, the surgical transposition of luxate, the surgical transposition of the greater trochanter can be the greater trochanter can be considered.considered.

Rupture of the Round Rupture of the Round Ligament of the Coxofemoral Ligament of the Coxofemoral

JointJoint

The hip joint of the horse has The hip joint of the horse has several ligaments to help hold it several ligaments to help hold it together. together.

The largest is the round The largest is the round ligament between the head of ligament between the head of the femur and the acetabulum.the femur and the acetabulum.

EtiologyEtiology::Trauma is the etiology of round Trauma is the etiology of round

ligament rupture. ligament rupture.

The same stresses that cause The same stresses that cause luxation of the coxofemoral joint can luxation of the coxofemoral joint can cause rupture without actual cause rupture without actual luxation. luxation.

In this case, the head of the femur In this case, the head of the femur has a greater range of motion than is has a greater range of motion than is normal, causing degenerative normal, causing degenerative changes in the joint.changes in the joint.

SignsSigns::

Signs of round ligament rupture are Signs of round ligament rupture are very similar to those of luxation. very similar to those of luxation.

The notable exception is that the The notable exception is that the limbs are of the same length. limbs are of the same length.

The signs that characterize round The signs that characterize round ligament rupture are toe-out, stifle-ligament rupture are toe-out, stifle-out and hock-in appearance of the out and hock-in appearance of the hind limb. hind limb.

This same appearance is also This same appearance is also present in luxation of the present in luxation of the coxofemoral joint, but the limbs are coxofemoral joint, but the limbs are uneven in length.uneven in length.

Right hind limb shows the classic stance of a ruptured round

ligament (toe-out and hock points more to the midline)

Crepitation over the joint may be Crepitation over the joint may be present because of the excessive present because of the excessive motion of the femur allowed by motion of the femur allowed by rupture of the ligament or because rupture of the ligament or because of osteoarthritic changes that occur. of osteoarthritic changes that occur.

Crepitation from these sources may Crepitation from these sources may be palpated either externally or per be palpated either externally or per rectum.rectum.

DiagnosisDiagnosis:: Diagnosis is based on the signs. Diagnosis is based on the signs.

If the horse is anesthetized and laid on its If the horse is anesthetized and laid on its back, a radiograph of the joint can be back, a radiograph of the joint can be taken. taken.

If the condition is of long standing, If the condition is of long standing, radiography will show sever degenerative radiography will show sever degenerative osteoarthritic changes. osteoarthritic changes.

Other wise, the abnormal position of the Other wise, the abnormal position of the femoral head in the acetabulum can be femoral head in the acetabulum can be identified.identified.

TreatmentTreatment::

There is no effective treatment, There is no effective treatment, except stabilization of the joint with except stabilization of the joint with a toggle pin apparatus. a toggle pin apparatus.

However, this is not practical in However, this is not practical in horses because the joint is never horses because the joint is never sound enough to permit galloping. sound enough to permit galloping.

This procedure is successful in This procedure is successful in cattle, but in cattle the gait seldom cattle, but in cattle the gait seldom exceeds a walk.exceeds a walk.

Hip Dislocation in DogsHip Dislocation in Dogs

The hip is the most commonly The hip is the most commonly luxated joint in small animals.luxated joint in small animals.

EtiologyEtiology::

The most common cause of acquired The most common cause of acquired hip luxation is trauma, with motor hip luxation is trauma, with motor vehicle accidents.vehicle accidents.

TypesTypes::

The majority of hip luxations are The majority of hip luxations are craniodorsal, presumbly because of craniodorsal, presumbly because of the type of injury and contraction of the type of injury and contraction of the gluteal muscles. the gluteal muscles.

The hip occasionally luxates The hip occasionally luxates caudoventrally, with displacement caudoventrally, with displacement of the femoral head into the of the femoral head into the obturator foramen, or rarely obturator foramen, or rarely caudodorsally. caudodorsally.

The hip may also luxate medially, in The hip may also luxate medially, in association with an acetabular association with an acetabular fracture. fracture.

The extent of soft-tissue damage The extent of soft-tissue damage that occurs with luxation depends on that occurs with luxation depends on traumatic forces, direction of traumatic forces, direction of luxation, and duration of the luxation, and duration of the luxation before definitive treatment .luxation before definitive treatment .

SignsSigns::

Hip luxation is suspected when an Hip luxation is suspected when an animal has a non-weight bearing animal has a non-weight bearing lameness of the hindlimb and a lameness of the hindlimb and a history of trauma.history of trauma.

The limb is usually held adducted, The limb is usually held adducted, with some external rotation if the with some external rotation if the luxation is craniodorsal. luxation is craniodorsal.

If the luxation is caudoventral, the If the luxation is caudoventral, the limb is usually held abducted, with limb is usually held abducted, with internal rotation.internal rotation.

Physical examination may reveal pain Physical examination may reveal pain and crepitus on flexion and extension and crepitus on flexion and extension of the hip joint.of the hip joint.

Comparison with the unaffected side Comparison with the unaffected side often reveals a disparity in position of often reveals a disparity in position of the greater trochanter and ischial the greater trochanter and ischial tuberocity.tuberocity.

DiagnosisDiagnosis::

Radiographic examination is Radiographic examination is necessary to confirm the necessary to confirm the diagnosis.diagnosis.

TreatmentTreatment::

Many methods have been described to treat Many methods have been described to treat hip luxationhip luxation::

a- Closed reduction and an Ehmer sling a- Closed reduction and an Ehmer sling application.application.

b- Modified De vita pinning with closed b- Modified De vita pinning with closed reduction.reduction.

c- Open reduction.c- Open reduction.

d- Others.d- Others.

Ehmer sling applicationEhmer sling application

A modified De Vita pinning technique A modified De Vita pinning technique was employed, using a nonthreaded was employed, using a nonthreaded Steinmann pin to reduce the risk of Steinmann pin to reduce the risk of trauma to the sciatic nerve during trauma to the sciatic nerve during pin insertion. pin insertion.

The pin was anchored by implanted The pin was anchored by implanted Kirschner-Ehmer clamps in an Kirschner-Ehmer clamps in an attempt to lower the risk of attempt to lower the risk of postoperative pin migration.postoperative pin migration.

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