Diagnostic procedures and surgical treatment of craniodorsal coxofemoral luxation in calves

Case report: Imaging of septic arthritis in the hip joint of a calf treated with femoral head ostectomy

A 24-day-old male Japanese Black calf presented with weight-bearing lameness in the left hind limb and a swollen pelvis. Ultrasonography revealed the accumulation of fluidity materials with a mixture of hyper- and hypo-echogenicity, enclosed by 5-10-mm-thick capsular structures. On the ventral-dorsal radiograph of the pelvis, irregular and radiolucent osseous changes were evident in the femoral head and acetabulum within the swollen hip joint, with soft-tissue density. Computed tomography (CT) confirmed the relationship between the bony and soft tissue lesions, which was suspected following ultrasonography and radiography, and provided additional findings, such as intra-articular accumulation of gas and the degree of osteolytic changes. Based on the imaging findings and cytology of the arthrocentesis specimen, the patient was diagnosed with hip arthritis and osteomyelitis of the femoral head. Additionally, the severity of the lesions supported our decision to perform a femoral head ostectomy. The postoperative radiographic and CT findings of the treated pelvis were helpful in evaluating the efficacy of this technique. Following treatment, the animal could walk and showed normal development, although it was three postoperative months before weight-bearing lameness improved. To the best of our knowledge, this is the first report to describe the combined use of ultrasonography, radiography, and CT in the diagnosis, preoperative planning, and evaluation of the postoperative effects of bovine hip arthritis. Additionally, this report details the therapeutic efficacy of femoral head ostectomy for bovine hip arthritis, a technique that has not been reported previously.

Bilateral dislocation of the hip joint and associated pathological changes in the ossa coxae and femora of a European roe deer (Capreolus capreolus)

We describe a bilateral craniodorsal dislocation of the hip joint in a free-ranging young roe buck and the associated pathological changes in the ossa coxae and femora of the animal. The highly symmetrical dislocation, which is considered to have developed secondary to hip dysplasia, caused the formation of two false acetabula that each consist of several, partially fused bone portions. The femora exhibit symmetrical outgrowths that extend from the greater trochanter along the intertrochanteric crest to the lesser trochanter. Formation of these outgrowths is attributed to abnormal traction at muscle attachment sites due to the displacement of the femora. On radiographic examination, both femora show signs of avascular necrosis in their head regions and of fatty marrow necrosis in their shafts, which is attributed to the damage of the arterial blood supply of the femora that was associated with the dislocation. The fact that, according to the hunter who shot the buck, the animal's locomotion was inconspicuous suggests that the false hip joints functioned quite well, thereby demonstrating a remarkable capacity of the musculoskeletal system for functional recovery.

[Diagnostic procedures and treatment of a ventromedial coxofemoral luxation in sheep - Surgery and open reposition of a ventromedial coxofemoral luxation with a toggle-pin and iliofemoral sling fixation]

A 2.5-year-old female Valais black-nosed sheep was referred to the University Clinic for Ruminants at the University of Veterinary Medicine Vienna, with a history of sudden lameness after shearing. The sheep showed a moderate mixed lameness of the right hind limb, the hip joint area was painful on palpation; the pelvic limb was presented as stretched as possible. After the clinical examination, the suspected diagnosis of a right-sided hip joint dislocation was made, which was subsequently confirmed radiologically (luxatio ossis femoris dextra to caudoventral and medial). An open, manual reposition was performed under general anesthesia. A toggle pin was used as a prosthetic ligament replacement for the femoral head ligament, further stabilization was achieved by means of an iliofemoral loop fixation within the fascia of the gluteal muscles.The movement possibilities of the sheep during the postoperative healing phase were severely restricted and 8 weeks of stall rest were ensured. The healing process was uncomplicated. Telephone enquiry 6 months following the surgical intervention revealed that the sheep was free of lameness, kept up with the herd, and displayed a normal general condition.The success of surgery and the use of the procedure in livestock practice is limited by the necessity of rapid intervention after the trauma has occurred, the willingness of the animal owner to bear the costs associated with the operation under general anesthesia as well as to ensure the long post-operative follow-up care with controlled restriction of movement.

Ultrasound is an accurate method compared to radiography for diagnosing the presence of acute hip luxation in cadaver dogs and can identify the direction of luxation with variable reliability

Acute hip luxation is a common musculoskeletal injury in dogs, with radiographs being the preferred imaging modality for confirming the diagnosis. In large animal and human medicine, ultrasound is often utilized for this purpose. The objectives of this three-part study were to utilize a canine cadaver model to establish ultrasonographic features of hip luxation and evaluate the accuracy and reliability for diagnosing hip luxation with ultrasound. For the first prospective, exploratory study, a cadaver model was developed that allowed manual luxation and subsequent ultrasonography of the hip joint while in four directions of luxation. For the second prospective, anatomic study, a description of the ultrasonographic features for each direction of luxation was created. For the third prospective diagnostic accuracy, observer agreement study, 16 residency-trained and intern veterinarians without prior experience in this technique performed randomized, repeated ultrasound exams on cadaver hips assigned as normal or luxated (equally distributed between the 4 directions). A total of 1140 hip ultrasounds were performed with good accuracy (median, 90.8%; range, 61.4-100%), sensitivity (89.5%), and specificity (80.0%) for diagnosing the presence of hip luxation. Accuracy for identifying the correct quadrant of luxation was significantly lower (mean, 58.6%; range, 24.6-90.8%; P < 0.001). Intraobserver accuracy agreement varied widely from none to almost perfect agreement, and interobserver agreement ranged from slight to moderate agreement. The results of this study supported the use of ultrasound for diagnosing the presence of hip luxation but did not support replacing radiographs for diagnosing the direction of luxation.

Ultrasonographic diagnosis of femoral fractures in large animals

OBJECTIVE

Femoral fractures are often catastrophic in large animals. Radiographic diagnosis is limited by patient size and feasibility, especially in ambulatory settings. Ultrasonography is widely available and may provide an alternative to radiography for definitive diagnosis.

ANIMALS

12 large animals (6 horses, 5 cattle, and 1 elephant).

PROCEDURES

Retrospective analysis of large animal patients diagnosed with femoral fracture by use of femoropelvic ultrasonography (2000 to 2019).

RESULTS

5 of 12 cases were ≤ 1 year of age. The remaining 7 cases were 2 to 33 years of age (median, 13 years). All patients developed severe acute lameness after falling (n = 4), limb entrapment (2), dystocia (1), vehicular collision (1), ipsilateral full limb casting (1), or unknown events (3). All were non-weight-bearing or lame at the walk, including 2 recumbent cattle. Ten cases showed upper limb swelling that was variable in location, and 3 had nonspecific upper limb crepitus. Ultrasonography revealed evidence of diaphyseal (n = 6), greater trochanteric (2), capital physeal (2), and distal femoral (2) fractures. Fracture movement during limb manipulation or weight shifting was sonographically visualized in 5 animals. Radiography confirmed fractures in 3 of 8 animals: 2 bovines with distal femoral fractures detected on standing projections and 1 capital physeal fracture that required ventrodorsal projections under general anesthesia. All animals were euthanized (11) or slaughtered (1 bovine). Postmortem examination confirmed ultrasonographic findings in 10 of 10 necropsied animals.

CLINICAL RELEVANCE

Femoral fractures were not localized nor confirmed in any case prior to ultrasonography. Study findings supported the use of ultrasonography for rapid patient-side diagnosis, prognostication, and decision-making in suspect cases.

Successful Treatment of Acute Craniodorsal Coxofemoral Luxation in a Scarlet Ibis (Eudocimus ruber) Using Closed Reduction and a Modified Ehmer Sling

Whereas craniodorsal displacement of the coxofemoral joint is the most common luxation reported in small and large mammals, it occurs less often in avian species. Closed reduction and external coaptation with a modified Ehmer sling is the initial treatment, in most cases, for small animals (eg, dogs, cats) that present with a coxofemoral luxation. However, the Ehmer sling is reported to have a low success rate in treating coxofemoral luxations in these animals. Intractable coxofemoral luxations require an open surgical reduction. A few successful closed reductions of coxofemoral luxations have been reported in avian patients, as well as open reduction surgical techniques to repair avian coxofemoral luxations. The successful treatment of an acute craniodorsal coxofemoral luxation in a scarlet ibis (Eudocimus ruber) with a closed reduction and a modified Ehmer sling is described in this clinical report. The specific characteristics of both the patient and the injury are thought to have contributed to the success in this case.

Diagnostic imaging in bovine orthopedics

Although a radiographic unit is not standard equipment for bovine practitioners in hospital or field situations, ultrasound machines with 7.5-MHz linear transducers have been used in bovine reproduction for many years, and are eminently suitable for evaluation of orthopedic disorders. The goal of this article is to encourage veterinarians to use radiology and ultrasonography for the evaluation of bovine orthopedic disorders. These diagnostic imaging techniques improve the likelihood of a definitive diagnosis in every bovine patient but especially in highly valuable cattle, whose owners demand increasingly more diagnostic and surgical interventions that require high-level specialized techniques.

Hip ontogenesis: how evolution, genes, and load history shape hip morphotype and cartilotype

BACKGROUND

Developmental hip disorders (DHDs), eg, developmental dysplasia of the hip, slipped capitis femoris epiphysis, and femoroacetabular impingement, can be considered morphology variants of the normal hip. The femoroacetabular morphology of DHD is believed to induce osteoarthritis (OA) through local cumulative mechanical overload acting on genetically controlled patterning systems and subsequent damage of joint structures. However, it is unclear why hip morphology differs between individuals with seemingly comparable load histories and why certain hips with DHD progress to symptomatic OA whereas others do not.

QUESTIONS/PURPOSES

We asked (1) which mechanical factors influence growth and development of the proximal femur; and (2) which genes or genetic mechanisms are associated with hip ontogenesis.

METHODS

We performed a systematic literature review of mechanical and genetic factors of hip ontogeny. We focused on three fields that in recent years have advanced our knowledge of adult hip morphology: imaging, evolution, and genetics. WHERE ARE WE NOW?: Mechanical factors can be understood in view of human evolutionary peculiarities and may summate to load histories conducive to DHD. Genetic factors most likely act through multiple genes, each with modest effect sizes. Single genes that explain a DHD are therefore unlikely to be found. Apparently, the interplay between genes and load history not only determines hip morphotype, but also joint cartilage robustness ("cartilotype") and resistance to symptomatic OA. WHERE DO WE NEED TO GO?: We need therapies that can improve both morphotype and cartilotype. HOW DO WE GET THERE?: Better phenotyping, improving classification systems of hip morphology, and comparative population studies can be done with existing methods. Quantifying load histories likely requires new tools, but proof of principle of modifying morphotype in treatment of DDH and of cartilotype with exercise is available.

Treatment of a coxofemoral luxation in a pony using a prosthetic capsule technique

OBJECTIVE

To report open reduction and joint stabilization using a prosthetic capsule technique for treatment of a craniodorsal coxofemoral luxation in a lightweight pony.

STUDY DESIGN

Clinical report.

ANIMALS

Pony stallion (8 years old, 113 kg).

METHODS

A craniodorsal approach to the coxofemoral joint was performed under general anesthesia. After open reduction, a prosthetic capsule technique was used. Four 3.5 mm self-tapping cortical anchor screws were implanted: 2 screws were inserted above the cranial aspect of the dorsal acetabular rim, and 2 screws were inserted into the femoral neck. Subsequently, a #5 USP ultra-high molecular weight polyethylene suture was placed through these anchor screws in figure-8 fashion to serve as a prosthetic capsule. Routine closure and a medial patellar desmotomy completed the surgical procedure. Postoperatively, the pony was cross tied for 4 weeks to prevent it from lying down.

RESULTS

Neither short-term nor long-term complications occurred and the pony was sound at the follow-up examination performed 15 months postoperatively.

CONCLUSIONS

A prosthetic capsule technique can be used successfully to stabilize the coxofemoral joint after open reduction of a craniodorsal luxation in a lightweight pony.

Ultrasonographic diagnosis of coxofemoral subluxation in horses

The clinical and ultrasonographic features of seven horses with coxofemoral subluxation are presented. Affected horses included five adult geldings (11-20 years), one large pony (6 years) and a 3-month-old filly. All were lame at the walk except for the pony with grade 3/5 lameness. Lameness was acute in all horses, but three horses progressed after initial improvement. Crepitus, muscle atrophy, and pelvic asymmetry were inconsistent findings. Ultrasonographic diagnosis of subluxation required dynamic visualization of femoral head displacement from the acetabulum while placing weight on the affected limb and subsequent replacement into its normal position upon limb resting. Acetabular rim fractures and joint effusion were visible regardless of weight bearing status in six horses each. No fractures were identified in the pony; the only patient with a good outcome. Six horses had a poor outcome with severe chronic lameness, four of which were euthanized. Postmortem ventrodorsal radiographs obtained in two horses confirmed subluxation only on extended limb projections, but not on hip-flexed projections. Acetabular rim fractures were not visible radiographically in either horse but were confirmed at necropsy. Subluxation was due to an elongated but intact ligament of the head of the femur in both horses. Osteoarthrosis was evident ultrasonographically, radiographically, and at necropsy. Dynamic ultrasonography was readily performed in the standing horse and produced diagnostic images with a low frequency curvilinear transducer. The apparent poor prognosis for horses with subluxation and acetabular fracture illustrate the importance of this imaging technique to identify affected horses.

Comparison of the diagnostic value of ultrasonography and standing radiography for pelvic-femoral disorders in horses

OBJECTIVE

To assess agreement between ultrasonography (transcutaneous and transrectal) and standing radiography in horses with fractures in the pelvic region and disorders of the coxofemoral joint.

STUDY DESIGN

Case series.

ANIMALS

Warmblood horses (n=23) and 2 ponies.

METHODS

Medical records (1999-2008) of equids with pelvic or coxofemoral disorders that had pelvic radiography and ultrasonography were retrieved and results of both techniques compared.

RESULTS

Radiography and ultrasonography each identified equal numbers of fractures of the tuber coxa (n=4), ilial shaft (2), ischium (3), femoral neck (2), and osteoarthritis/osis of the coxofemoral joint (6). Fractures of the ilial wing (4) were only identified by ultrasonography not by standing radiography. Of 9 acetabular fractures, 3 were identified on radiographs only, 5 were identified with both modalities. One pubic fracture was identified using ultrasonography and radiography. One acetabular and 1 pubic fracture were only diagnosed on necropsy.

CONCLUSIONS

We found reasonable agreement (73%; 24/33) between ultrasonography and standing radiography for diagnosis of pelvic-femoral disorders. Ultrasonography was more useful for ilial wing fractures and radiography for acetabular fractures.

CLINICAL RELEVANCE

Ultrasonography is a rapid, safe imaging technique for detecting disorders of the pelvic region with a high diagnostic yield and is a preferred initial approach in horses with severe hindlimb lameness.