Content continues after advertisement

The Ehmer Sling in Canine Orthopedic Surgery

James K. Roush, DVM, MS, DACVS, Kansas State University

Walter C. Renberg, DVM, MS, DACVS, Kansas State University

Orthopedics

|August 2015|Peer Reviewed

Sign in to Print/View PDF

The Ehmer Sling in Canine Orthopedic Surgery

Case Selection & Management

Proper case selection for Ehmer or Figure-8 sling use is critical to a successful outcome. The Ehmer sling was designed to maintain the head of the femur in the acetabulum after closed reduction of a craniodorsal coxofemoral luxation, to prevent weight bearing, and to limit hip motion during healing. It should not be used in dogs with ventral coxofemoral luxation, which should be treated with hobbles to prevent limb abduction.

Related Article: Closed Hip Reduction

Best results are obtained in dogs with acute luxations <24 hours in duration with temperaments amenable to confinement and continual bandage care. Ehmer slings should not be applied to dogs with luxations of >1 week duration, luxations associated with fractures of the adjacent acetabulum, poor hip comformation (hip dysplasia), or dogs that are unable to ambulate on the contralateral limb. Ehmer slings can be difficult to apply in obese or chondrodystrophic dogs. Ehmer slings may be useful after internal fixation of acetabular or femoral head and neck fractures to temporarily prevent weight bearing.

Best results are obtained in lean, calm dogs with acute luxations <24 hours in duration.

Success of Ehmer sling application is enhanced by appropriate technique during reduction. Hip radiographs must be taken and evaluated before reduction to identify dogs with acetabular fractures or ventral luxations and are not candidates for Ehmer sling application. Reduction should be attempted in anesthetized dogs with craniodorsal hip luxations. Reductions are best accomplished by a manipulative sequence composed of external rotation of the affected limb while simultaneously providing distal traction to the limb and countertraction to the inguinal area. While traction is maintained, the limb should be internally rotated and simultaneous distal pressure to the greater trochanter applied to facilitate reduction. After reduction and before sling application, the coxofemoral joint should be put through multiple complete range-of-motion exercises while medial pressure is applied to the greater trochanter to clear the acetabulum. Orthogonal radiographs of the affected hip should be performed and evaluated after Ehmer application to confirm reduction of the coxofemoral joint.

Aftercare

Daily examination of the hip and Ehmer sling determines effectiveness of the sling for maintenance of internal rotation, flexion of the coxofemoral joint, and limb abduction. Loss of internal rotation, hip flexion, or abduction are indications for immediate sling replacement. The position of the greater trochanter in ventral relationship to a line that connects the ilial wing and ischiatic tuberosity should be palpated daily to confirm continued hip reduction, and the joint should be palpated through a shortened range of motion to confirm continued smooth function. The flank, abdomen, and distal limb are examined daily for sores, inflammation, and edema. If pressure sores or wounds develop, modify the sling or remove it immediately. Monitor the abdominal band in male dogs for urine contamination and irritation of the underlying skin.

Maintain the Ehmer sling for a minimum of 7 to 10 days (maximum, 14 days) and remove only after coxofemoral reduction is confirmed by repeated orthogonal radiographs. Reluxation rates of 15% to 71% have been reported after closed reduction1; however, the specific reluxation rate after closed reduction and Ehmer sling application has not been reported. Owner evaluation scores are better after closed reduction than after femoral head and neck excision, extracapsular suture stabilization, and De Vita pinning.2 Direct comparisons of recurrence rates or owner satisfaction between closed reduction, Ehmer sling, and more recently developed techniques (eg, toggle pin, rod repair) have not yet been reported.

Related Article: Effective Casting Techniques

Dogs should be kept under cage confinement for the period of Ehmer sling application and for a minimum of 4 weeks after removal. Voluntary use of the limb by the patient should begin within 1 or 2 days as stiffness decreases, then gradually increase on a daily basis following removal of the sling. Gentle physical rehabilitation consisting of daily hip range-of-motion exercises can be initiated 4 to 6 weeks after sling removal. Controlled leash walks or underwater treadmill therapy may also be beneficial to restore normal use and function.

What You Will Need

  • 1 to 2 rolls of 2-inch wide porous, nonelastic adhesive tape.

WALTER C. RENBERG, DVM, MS, DACVS, is professor and section head of small animal surgery at Kansas State University. Dr. Renberg, who has more than 20 years of experience as orthopedic surgeon, is co-author of the textbook Small Animal Bandaging, Casting, and Splinting Techniques.

JAMES K. ROUSH, DVM, MS, DACVS, is Doughman professor of surgery at Kansas State University. He has more than 30 years of experience in veterinary orthopedic and neurologic surgery, small animal orthopedic research, and surgical training of residents and students. Dr. Roush earned his DVM from Purdue University and his MS from University of Wisconsin–Madison.

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Clinician's Brief may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.

Podcasts

Clinician's Brief:
The Podcast

Listen as host Beckie Mossor, RVT, talks with the authors of your favorite Clinician’s Brief articles. Dig deeper and explore the conversations behind the content here.
Clinician's Brief provides relevant diagnostic and treatment information for small animal practitioners. It has been ranked the #1 most essential publication by small animal veterinarians for 9 years.*

*2007-2017 PERQ and Essential Media Studies

© Educational Concepts, L.L.C. dba Brief Media ™ All Rights Reserved. Privacy Policy (Updated 05/08/2018) Terms of Use (Updated 05/08/2018)