Closed Hip Reduction

Coxofemoral luxation is the most frequently encountered luxation in veterinary medicine. Traumatic coxofemoral luxations cause disruption of the joint’s supportive structures, resulting in damage to soft tissues (such as the round ligament, joint capsule and surrounding musculature) and articular surfaces.

Reducing the hip as quickly as possible:

• Minimizes damage to the articular surfaces
• Restores nutrition to the cartilage
• Decreases formation of muscular contraction and fibrosis
• Decreases accumulation of debris within the acetabulum.

A physical examination (reflecting loss of the spatial “triangle” between the crest of the ilum, tuber ischii, and greater trochanter) will confirm the diagnosis. Orthogonal radiographs should be performed to evaluate the extent of the injury and provide a baseline for therapeutic decisions.

Figure 1: Typical stance of a dog with craniodorsal hip luxation

Indications
Closed reduction should be attempted immediately in the absence of:

• Fractures of the acetabulum, including avulsion of the fovea capitis

• Femoral head and neck fractures
• Advanced degenerative disease secondary to hip dysplasia.

What You Will Need

• One or 2 volunteers
• Scissors
• Clippers
• Sedation and general anesthesia (consider epidural analgesia)
• Rope, towel, or sheet
• Elastikon (jnj.com)
• Cast padding
• Telfa or Tendersorb (tycohealthcare.co.uk)

Step by Step Closed Hip Reduction

• Palpation of landmarks (ilial crest, tuber ischii, greater trochanter)
• Measurement of the width of the space between the greater trochanter and tuber ischii
• Restoration of limb length. Comparison to the contralateral side may offer an additional guideline.

Step 5
Multiple strips of Elastikon are cut at this point. These strips should be long enough for application from the metatarsals (including a stirrup) to the dorsum while the limb is in a flexed position.

Step 6
Application of the Ehmer sling begins by placing layers of cast padding around the metatarsals; then adding multiple strips of Elastikon, starting as a stirrup distally and ending proximally across the dorsum. The limb should be firmly flexed and pressure maintained on the greater trochanter, since the limb is abducted during sling placement.

Author Insight
In the case of luxations of greater duration (2 to 5 days), overcoming contraction and fibrosis of soft tissues is critical. Distraction of the limb, using a rope or sheet wrapped in the inguinal area, and countertraction of the limb should be done prior to attempts at hip reduction.

Step 8
Repeat the process of strip placement until the flexed position is stable (typically 3–5 Elastikon strips). As the Elastikon strips are added distally, they should be distributed along the length of the metatarsals. This helps with distribution of pressure along the limb and decreases the chances of constriction and

Step 11
In the case of ventral luxations, the femoral head can often be manipulated back into the acetabulum by applying lateral and cranial pressure on the greater trochanter with one hand and traction against the ischium with the other hand. If the reduction proves to be stable, hobbling the rear legs together for a period of 10 days should allow sufficient time for soft tissues to begin to fibrose and heal.

Post Procedure Period
Reports of closed hip reduction indicate success in approximately 50% of cases. Though reduction maintenance in hip luxations can be difficult, close monitoring of the bandage every 3 to 4 days is critical for fibrosis and hip stabilization to occur. At this time, the hip can be checked to ensure that reduction is being maintained.

There are various recommendations for bandage placement duration; however, the minimum amount of time for Ehmer sling placement is 14 days, if the sling is being tolerated. Upon removal of the Ehmer sling, orthogonal view radiographs should be taken. Kennel confinement is recommended for a period of at least 4 to 6 weeks.

Complications
Potential complications with the bandage include:

• Skin excoriation and dermatitis
• Bandage slippage
• Faulty placement or adherence of the bandage that may cause failure to fully support the limb, resulting in ischemic necrosis of the distal limb.

CLOSED HIP REDUCTION • Laura E. Peycke

Suggested Reading

1. Closed hip reduction. Piermattei DL, Flo GL, DeCamp CE. Brinker, Piermattei, and Flo’s Handbook of Small Animal Orthopedics and Fracture Repair, 4th ed—St. Louis: Saunders Elsevier, 2006, pp 461-467.
2. Coxofemoral luxation. Holsworth IG, DeCamp CE. In Slatter D (ed): Textbook of Small Animal Surgery, 3rd ed—Philadelphia: WB Saunders, 2003, pp 2002-2004.
3. Coxofemoral luxation. Schulz K. In Fossum T (ed): Small Animal Surgery, 3rd ed—St. Louis: Mosby, 2007, pp 1246-1249.
4. Traumatic joint luxations in small animals. McLaughlin RE. Vet Clin North Am Small Anim Pract, Manag Ortho Emer 25:1176-1180, 1995.