Traumatic Luxation Research Articles

Use of bone anchors for the treatment of partial and complete traumatic elbow luxations: A retrospective case series of three dogs

AbstractThree dogs presented with traumatic lateral elbow luxation following road traffic accidents. Concurrent injuries included skin abrasions and coxofemoral luxation. All luxations were reduced and stabilised with bone anchors through a lateral approach to the elbow joint and had an augmented or prosthetic lateral collateral ligament placed. One elbow joint was stabilised with FASTak anchor (Arthrex, Karsfeld, Germany) and two with suture anchors by IMEX bone anchor (Veterinary, Longview, TX). Reluxation occurred in one case 24 hours after discharge requiring revision surgery. Median follow‐up time for the three cases was 180 days (range: 49–2920) and the functional outcome was considered excellent in all cases as determined by veterinary assessment, clinical record reviews, owner communication and Liverpool Osteoarthritis in Dogs (LOAD) questionnaire. In conclusion, placement of bone anchors with augmentation of the lateral collateral ligament for management of traumatic elbow luxation in dogs is a good alternative to previously reported surgical techniques.

Long-Term Follow-Up of Dogs and Cats after Stabilization of Thoracolumbar Instability Using 2-0 UniLock Implants.

Traumatic vertebral fracture or luxation often results in spinal instability requiring surgical stabilization. This study describes the long-term outcome of spinal stabilization using a unilateral 5-hole 2-0 UniLock implant in eight dogs and two cats with trauma-induced thoracolumbar vertebral luxation/subluxation and presumed instability, as assessed by a combination of preoperative radiographs and MRI using a 3-compartment method. The UniLock plate was secured with four monocortical locking screws in adjacent vertebral bodies. Additional pins and facet screws were used in several patients. Postoperative radiographs and MRI studies showed restoration of the main spinal axis in all patients and satisfactory implantation of the screws in the vertebral bodies, with no intrusion in the vertebral canal or in the adjacent intervertebral disc spaces. Neurological status improved in nine patients six weeks postoperatively. Partial implant failure was detected in three patients with no long-term consequences. After 12 months, seven patients reached full recovery with no neurological deficit, two patients were euthanized (including one owing to an unrelated condition), and one remained paraparetic. The results of this study demonstrate that using a 2-0 UniLock implant to stabilize the thoracolumbar spine results in satisfactory long-term recovery in most dogs and cats with traumatic spinal luxation/subluxation and presumed instability. Complications may occur but do not require revision surgery and do not affect clinical outcomes.

Traumatic stapes luxation requiring removal of the stapes and ossicular reconstruction using Apacerum-C

Traumatic stapes luxation requiring removal of the stapes and ossicular reconstruction using Apacerum-C

Open hip reduction using a novel transarticular suture stabilisation technique in 24 dogs: a retrospective study of technique, outcome and complications

Case history: Medical records of a single private practice (Illinois, USA) were retrospectively reviewed to identify dogs (n=24) that had an open hip reduction with a transarticular suture stabilisation technique after presenting with a traumatic coxofemoral luxation between April 2003 and December 2018. Clinical findings: Dogs that met the inclusion criteria were of various breeds with a median body weight of 18.1 (min 4.2, max 54.5) kg and mean age at presentation of 6.5 (min 1, max 11) years. The surgical technique, short term outcome and complications were extracted from the medical records. Long-term (>2 years) follow-up data was obtained by a telephone interview with each owner. Treatment and outcome: All dogs underwent open hip reduction using a novel transarticular suture stabilisation technique. The outcome was reported by owners to be excellent in (18/24) 75% dogs with full return of limb function. Sixty-six percent (16/24) of owners reported that no lameness was observed 2 months after surgery. No minor complications were noted in this study. The hips of 6/24 (25%) dogs reluxated after surgery (defined as a major complication), which required femoral head and neck excision surgery. Clinical relevance: Open coxofemoral joint reduction using a novel transarticular suture technique is a viable surgical option to consider in dogs that present with a traumatic coxofemoral luxation.

Contralateral field defect in traumatic globe luxation with optic nerve injury

ABSTRACT Clinical relevance: Traumatic globe luxation is rare vision-threatening event. Besides causing loss of vision in traumatised eye, it may also cause injury to contralateral optic nerve. Any such limitation in a one-eyed patient can make him crippled in his day-to-day activities. Here we hypothesise cause of contralateral field defect in such patients. Background: Traumatic globe luxation is a rare event that leads to profound vision loss due to injury of the ipsilateral optic nerve and rarely a visual field defect in the contralateral eye. Through this communication, we report similar case scenarios and intend to hypothesize the mechanism that results in the occurrence of the contralateral visual field defect. Methods: It is a retrospective, observational study. All cases with traumatic globe luxation were enrolled. Visual field analysis of the contralateral normal eye was main outcome measure. Results: Four patients with traumatic globe luxation and optic nerve injury were studied. There was complete loss of vision in the traumatised eye in all the patients. One patient had complete transection of the optic nerve, whereas in three patients, the course of the optic nerve was intact, on imaging. Three patients had quadrantanopia in the contralateralnormal eye for which oral steroids were given. At 1-month follow-up, there was complete recovery of the visual field defect in two patients. We noticed that all the three patients with an intact course of the ipsilateral optic nerve had quadrantanopia in the contralateral normal eye. Conclusion: We hypothesize that in scenarios where globe luxation is associated with incomplete transection or no transection of the optic nerve, a continuous long standing stretch on the optic nerve, transmits the pulling force to the chiasma which might result in a contralateral field defect as compared to those associated with the complete transection of the optic nerve.

Custom-built constrained uniaxial and rotating hinge total knee replacement in cats: Clinical application, design principles, surgical technique, and clinical outcome.

To describe the design principles and evolution, surgical technique, and outcome for custom constrained (uniaxial and rotating hinge) total knee replacement (TKR) in cats. Retrospective case series. Nine cats with traumatic stifle luxation (n=8) or severe distal femoral deformity (n=1) were considered suitable candidates. Cats that met eligibility criteria and received a custom TKR between 2009 and 2018 by a single surgeon were included in this case series. Three generations of implant were used. Implant positioning was assessed by postoperative orthogonal radiography. Functional outcome was determined by clinical assessment, owner interview, and a feline musculoskeletal pain index questionnaire. Median clinical follow-up time was 12 months (range, 4-41); follow-up time was increased to 29 months (range, 22-47) when results of functional questionnaires with owner were included. Median radiographic follow-up was 12 months (range, 4-25). One cat had a catastrophic outcome. Three cats had good outcomes, and five cats had excellent outcomes. Most cats treated with custom-built TKR achieved good to excellent outcomes. Custom TKR is a viable option for the treatment of severe pathologies of the feline stifle. Additional research is required to fully evaluate implant suitability.

Ílio-femoral suture with polyglecaprone thread to stabilize traumatic hip dislocation in a dog

Traumatic hip dislocations are orthopedic injuries commonly seen in the routine of the surgical clinic in pets such as dogs and cats. The aim of this study is to report a clinical case of the ilio-femoral suture technique with polyglecaprone thread to stabilize traumatic coxofemoral luxation in dogs. A mixed breed dog, three years old, with a body weight of 8.90 kg, was taken to the Veterinary Hospital of the Faculty of Veterinary Medicine and Zootechnics, presenting as a main complaint, a pedestrian hit over ten days ago and since then without support of the left pelvic limb. During the initial evaluation, it was found that the animal had functional impotence of the aforementioned limb. As a complementary examination, a ventro-dorsal and latero-lateral radiography of the pelvis region was requested. After diagnosing the hip dislocation with cranio-dorsal displacement of the femur, surgical treatment was instituted using the iliofemoral suture technique. The use of the ilio-femoral suture technique with absorbable suture was efficient in the treatment of craniodorsal hip dislocation in the patient in the present report, with return of limb functionality and regression of clinical signs.

Diagnostic Imaging of Patellofemoral Instability.

Throughout the literature, patellofemoral instability (PI) is defined as an increased risk of re-/luxation of the patella within the patellofemoral joint (PFJ). In most patients it is caused by traumatic patella luxation or the existence of a range of predisposing anatomic risk factors leading to an unphysiological movement sequence within the PFJ also known as patellofemoral maltracking. In order to provide an individualized therapy approach, clinical and radiological evaluation of those risk factors of variable magnitude becomes essential. Diagnostic imaging such as magnetic resonance imaging (MRI), plain radiography, and computed tomography (CT) are straightforward diagnostic tools in terms of evaluation and treatment of PI. In this review we performed a precise analysis of today's literature concerning the radiological evaluation of anatomic risk factors leading to PI. The purpose of the review is to present a logical compilation of the different anatomical risk factors causing PI and provide a straight overview of valuable radiological imaging techniques. PI is frequently based on a multifactorial disposition. The most relevant predisposing risk factors are trochlea dysplasia, rupture of the medial patellofemoral ligament (MPFL), patella alta, abnormal tibial tubercle to trochlea groove distance (TT-TG), femoral torsion deformities, and genu valgum. Although plain X-rays may provide basic diagnostic value, cross-sectional imaging (MRI, CT) is the standard radiological tool in terms of evaluation and detection of severity of predisposing anatomic variants leading to PI. · Based on today's literature, PI is characterized as an increased risk of patella re-/luxation within the PFJ.. · Underlying anatomic risk factors of variable magnitude mark the pathological cause of PI.. · Modern diagnostic imaging (MRI and CT) permits straightforward diagnosis of the typical features in terms of PI.. · To provide an individualized therapy approach, precise radiological evaluation and determination of the severity of predisposing anatomic anomalies are essential.. · Maas KJ, Warncke ML, Leiderer M et al. Diagnostic Imaging of Patellofemoral Instability. Fortschr Röntgenstr 2021; 193: 1019 - 1033.

Traumatic joint luxations in cats: Reduce, repair, replace, remove.

Traumatic joint luxations are usually associated with significant trauma and there may be concomitant systemic injury. Joints are unstable as a result of injury to one or more supporting structures and the clinician should aim to determine which structures are damaged with physical examination, diagnostic imaging and careful assessment under sedation/anaesthesia. The aim is to reduce the joint back to its anatomical position, and then to maintain this through repair of damaged structures. However, where this is not possible, replacement or removal (arthrodesis/excision arthroplasty) of the joint remain viable options. Owing to the small size of feline joints and the severity of damage often seen, surgical management of these cases can be challenging. The first priority is to ensure the patient is systemically well before embarking on any specific surgical treatment of a luxated joint. Cats also present challenges in the postoperative period and a lack of patient and owner compliance can be detrimental to postoperative outcomes. This article aims to help the reader diagnose joint luxations and to assist decision-making with an overview of the management and treatment options available. There are a number of original articles and textbook chapters in the literature covering aspects of different joint luxations, particularly for the more common luxations. This article draws on information from key feline research and, where necessary, extrapolates from relevant canine research. The authors also offer practical guidance based on their own clinical experience.

Patellar luxation in rabbits (Oryctolagus cuniculus): 6 cases (2017-2020)

Four cases of patellar luxation in rabbits have been reported in the literature, but the prevalence and etiology are unknown. This study aimed to characterize the presentation, anamnesis, prevalence, etiology, and treatment options for patellar luxation in rabbits. Medical records of 1249 rabbits presented to the Exotic Animal Service between January 2017 and March 2020 were reviewed. Data collection of the rabbits with patellar luxation included signalment, patient history, onset of lameness, position and grade of the luxation, radiographic findings, treatment, and clinical outcome. Six rabbits met the inclusion criteria (0.48% prevalence). The chief complaint in all rabbits was acute onset of hind limb lameness, ranging from weight-bearing to nonweight-bearing. The luxation was unilateral in all cases and ranged from grades II to IV. Four rabbits were managed medically with cage rest, but acute recurrence of the luxation was seen in two 18-month-old animals with grade III patellar luxation. Two 4-month-old animals with grade II patellar luxation responded well to medical treatment. Three rabbits, including one medically managed rabbit that reluxated, were managed surgically using soft tissue reconstruction described in dogs with traumatic patellar luxation. The methods included medial desmotomy, lateral imbrication, fabellotibial, and fabellopatellar sutures to stabilize supporting femoropatellar structures. A trochlear sulcoplasty was performed in one rabbit with grade IV luxation. At 12–24 months follow-up, reluxation had not occurred in the three rabbits. Patellar luxation is an uncommon cause of hind limb lameness in rabbits. Both medical and surgical treatment provided a good long-term outcome in five out of six patients. The surgery was relatively straightforward and took less than 1 hour in experienced hands. Further research is needed to determine the causes of patellar luxation in rabbits and to assess the indications, advantages, and complications of both treatments.

Комбинированная хирургия с имплантацией ИОЛ при травматической люксации хрусталика и афакии

Комбинированная хирургия с имплантацией ИОЛ при травматической люксации хрусталика и афакии

Iliofemoral technique modification using an anchor screw as treatment of canine traumatic hip luxation - case report

ABSTRACT Twelve dogs with traumatic hip luxation were selected for surgical intervention with a modified iliofemoral suture technique using an anchor screw to substitute the passage of suture material through a perforated tunnel in the ilium. Six procedures were performed with non-absorbable suture and other six with absorbable suture materials. These cases were evaluated at 15, 30, 60, and 90 days after surgery by performing an ambulation analysis and palpation of the joint. In all cases, there was a return of partial and total limb support in an average of 3 and 19 postoperative, respectively. The fixation strategy of the suture material in the ilium using an anchor screw proved to be efficient with a smaller surgical approach and lesser surgical difficulty, maintaining joint congruence in acute as chronic luxation cases. The use of absorbable and non-absorbable sutures had excellent clinical results, but there was a subjective superiority of the first ones, once 4 dogs of the non-absorbable group presented some discomfort during the postoperative palpation of the joint, 90 days after surgery.

ESTABILIZAÇÃO UMERORRADIAL COM PARAFUSOS E POLIÉSTER TRANÇADO EM CÃO COM LUXAÇÃO TRAUMÁTICA DE COTOVELO

Objetivou-se descrever o caso de um cão com luxação traumática de cotovelo que obteve bons resultados após correção ortopédica com parafusos e poliéster trançado. O tutor referiu que animal evadiu-se de sua residência e retornou após 3 dias sem apoiar o membro torácico esquerdo. O paciente foi encaminhado a clínica veterinária Uningá após 12 dias de seu retorno. Na avaliação clínica pôde-se observar: claudicação sem apoio do membro torácico esquerdo, dor, crepitação e instabilidade da articulação do cotovelo com deslocamento lateral da cabeça do rádio e do olécrano em relação ao úmero distal. Confirmou-se o diagnóstico de luxação lateral do cotovelo pelo exame radiográfico. O paciente foi submetido à cirurgia ortopédica e após 15 dias do procedimento cirúrgico, observou-se boa cicatrização da ferida com discreta claudicação do membro operado. Após 90 dias de pós-operatório o paciente apresentava boa deambulação, sem indícios clínicos de claudicação, dor, instabilidade e crepitação do membro operado. Concluiu-se então com este relato que o uso dos parafusos associados ao fio de poliéster trançado em figura de “8” foram uma boa opção no tratamento da luxação traumática de cotovelo.

Risk factors for reluxation after toggle rod stabilization for treatment of coxofemoral luxation in 128 dogs.

Evaluate the risk factors for reluxation and outcomes for dogs with a toggle rod construct. Retrospective case series. One hundred twenty-eight client-owned dogs. Medical records from 2007 to 2018 were reviewed for signalment, history, surgery, and outcome for dogs with a coxofemoral luxation repaired with a commercial toggle rod and nylon monofilament suture construct. Univariate and multiple logistics regression analysis were performed to assess risk factors associated with postoperative luxation. Primary veterinarians and owners were contacted for follow-up via telephone or electronic communication. The overall complication rate was 24.2%, and the reluxation rate was 14.8%. There was a decreased risk of reluxation when the cause was traumatic in origin (odds ratio [OR] 0.10) or when the lameness was severe at presentation (OR 0.42). Fifteen of 58 (25.9%) owners contacted completed a follow-up survey. Dogs with nontraumatic, low impact luxations were at a higher risk for reluxation. Dogs of any body condition with a traumatic coxofemoral luxation are at lowest risk for reluxation.

Computed Tomographic Diagnosis of Traumatic Atlanto-occipital Rotatory Luxation and Successful Closed Reduction in a Dog

AbstractA 12-year-old, female spayed crossbred dog was presented for traumatic injuries sustained after being hit by a car. The dog was non-ambulatory with a right-sided head tilt on presentation, neurological deficits and signs of external trauma centred on the head. A trauma computed tomography was performed which revealed an atlanto-occipital luxation with narrowing of the vertebral canal. This was treated successfully via closed reduction and confirmed with a repeat computed tomography scan. The dog recovered well following the atlanto-occipital luxation reduction, and was ambulatory the day after the reduction, and neurological signs resolved within 2 days.

MPFL Reconstruction Using Quadriceps Tendon Graft - Our Five Years Expirience

The primary traumatic luxation of the knee cup affects the general population with an incidence of 5.8 per 100,000 (3), while in the younger age group (10-17 years) it goes up to 29 per 100,000. Most patients will not have instability after non-operative treatment, while repeated luxation will occur in 15 to 44% of cases. The use of the quadriceps tendon for medial patelofemoral ligament (MPFL) reconstruction is a method described independently by Steensen et al. and Noyes and Albright. Today have more and more supporters because of their simplicity, minimal trauma and good postoperative results. Reconstruction of MPFL with quadriceps tendon (QT) for recurrent patellofemoral instability started in our Clinic in 2014. Indications for surgery were patients who have had clear clinical and radiological signs of instability, tibial tubercle-trochlear groove distance (TT-TG) < 20 mm, dysplastic trochlea grade A according to the Dejour classification. For clinical testing we used apprehension and Veselko's test. In our clinic 22 patients were operated in past fifth years. This study shows result of 17 patients. We noticed a significant improvement in patients in daily activities (instability, swelling, pain, kneeling, squatting, climbing stairs). All patients had full range of motion after approximately 3 months. The initial Lyscholm score value was 69.2 ± 6.4 while after two years 88.3 ± 3,2. Our observation shows that MPFL reconstruction with quadriceps graft in short time follow-up in selected cases may have very satisfactory results. The method itself is simple, inexpensive, with small complication rate and with great patients satisfaction.

A Closer Look is necessary: Traumatic luxation of the patella as a co-injury of an acl-rupture

Aims and Objectives:The rupture of the acl is considered to be one of the most common knee injuries in sports traumatology. Many patients report that they felt the sensation of a luxated patella during their knee distorsion. In many cases patients patients with the suspicion of a traumatic patella luxation showed in the mri a complete rupture of the acl.Materials and Methods:We report about 10 patients consulting our department within the last year after a significant knee trauma. In the mri as well as during the arthroscopic evaluation they showed a complete rupture of the acl as well as the findings of a fresh, traumatic patella luxation. We evaluated and analysed the preoperative and intraoperative pictures (mri and arthrosopy).Results:All patients showed in the posttraumatic mri a complete rupture of the acl as well as an at least partial rupture of the mpfl and a rupture of the medial retinaculum. 4 patients showed a persistent subluxation of the patella, 8 patients showed also a rupture of the medial collateral ligament. During the operation we verified a significant instability of the patella in 8 patients so that a stabilization of the patella was performed (open medial stabilization or mpfl reconstruction) in the same operation the acl was reconstructed (semi-t).Eventhough the patients were treated with only one operation and the regaining of motion was prolonged compared with isolated acl-reconstruction, after 12 months postoperatively all patients had a satisfactory range of motion.Conclusion:The typical trauma mechanism for an acl rupture is a valgus position of the knee in combination with an external rotation of the tibia, which leads to an enlargement of the q-angle which is considered a predisposition for a patella luxation. If an acl rupture occurs, the patella can luxate within the same trauma. In the posttraumatic mri the rupture of the mpfl is often misinterpreted as a rupture of the medial collateral ligament, particularly if the patella is, as in most cases, in full reposition. Within an acl-rupture a luxation of the patella can occur simultaneously, leading to a significant instability which needs to be treated (medial stabilization or mpfl-reconstruction). Our data shows that a single stage treatment with acl-reconstruction and medial stabilization is technical practicable and mid-term investigation shows good clinical results without a higher risk of an arthrofibrosis.

Multi-centre retrospective study of the long-term outcome following suspected traumatic elbow luxation in 32 cats.

To describe reduction techniques and clinical outcome in a series of traumatic elbow luxations in cats. Retrospective review of unilateral elbow luxations treated at five specialist referral centres. Data included signalment, aetiology, concurrent injuries, luxation direction, time to reduction, primary reduction technique, surgical procedure and complications. Cases were excluded if reduction technique was unknown. Telephone owner questionnaire follow-up was completed using a Feline Musculoskeletal Pain Index. Thirty-two cats were included. Lateral luxations were most common (n=21). Time (hours) until attempted initial closed reduction was <24 (n=12), 24-48 (n=13), >48 (n=3) or unrecorded (n=4). Luxation was treated by closed reduction alone (n=7) or by surgery (n=25); 14 of 25 cases underwent primary surgical reduction and 11 of 25 were secondary procedures following failure of closed reduction. Transcondylar bone tunnels and circumferential suture (n=19) was the most commonly used surgical technique. Catastrophic (n=1), major (n=11) and minor complications (n=5) were recorded; reluxation occurred more frequently after closed reduction (n=8) than after open reduction with fixation (n=0). Feline Musculoskeletal Pain Index data were available for 12 cats; outcome was good-excellent in all 12, with a median function score of 64.5/68 (range: 55-68) and a median pain score of 0/15 (range: 0-5). Outcome was not associated with reduction technique. Elbow reluxation occurred in 61% of cats following primary closed reduction but did not occur in any open reduction cases. Reluxation rate increased with duration from injury. Most cats had good-excellent owner-assessed outcome, regardless of reduction technique.

Open reduction of a traumatic left scapulohumeral luxation in a degu (Octodon degus) - a case report

Open reduction of a traumatic left scapulohumeral luxation in a degu (Octodon degus) - a case report

Isometry of Potential Attachment Sites for the Iliotrochanteric Suture in Dogs: an ex vivo Study

Background: Coxofemoral luxation is the most common traumatic luxation in dogs and the iliotrochanteric suture is one of the surgical treatment options. The orthopedic suture aimed at surgically restoring joint movement should be employed in an isometric manner in order to maintain adequate tension throughout the arc of motion. This study aimed to determine the isometric points for the iliotrochanteric suture in dogs during the joint extension and flexion movements. This evaluation was performed both in the intact hip joint and in the luxation model, establishing the best combination, among the determined points, for the reestablishment of normal joint movement.Materials, Methods &amp; Results: Radiographic analyses of 12 canine cadaveric hips, both intact and in craniodorsal luxation model, were performed in a neutral position, flexion at 50°, and extension at 150°. In the trochanteric segment, two parallel lines were drawn, creating the central vertical axis and the secondary vertical axis. Three points were then determined on each axis, from proximal to distal, corresponding to 25, 50, and 75% of the height of the axis, and were labelled as T1, T2, and T3 and T4, T5, and T6, respectively. In the iliac segment, a line perpendicular to the longitudinal axis of the ilium was drawn, and 25, 50, and 75% of this height corresponded to points I1, I2, and I3, respectively. The lengths between the points were measured, with the objective of evaluating which combination of points presented less variation in the joint positions. The central location of the iliac and trochanteric segments, determined respectively by I2 and T2, provided smaller variations during the maximal movements of hip flexion and extension.Discussion: The surgical techniques of iliotrochanteric suture target to maintain the internal rotation of the femoral head inside the acetabulum and abduction of the femur until the soft tissues have healed. The described techniques for the iliotrochanteric suture present a great anatomical variety in the arrangement of the anchor points of the suture. It is known that if during motion, the attachment sites move closer to one another, the suture will become lax and, if the attachment sites move away from one another, the suture will tighten. Therefore, the implantation in isometric sites assists in reducing the variation of the distance between the points of origin and insertion of the suture during joint movement, keeping the suture tension constant and allowing the functional recovery of the joint. This study demonstrates that there are some locations for the origin and insertion of an iliotrochanteric suture that are associated with less length change than others. I2-T2 combination is the point closest to isometry for the iliotrochanteric suture during hip extension and flexion, so that, T2 is the most central point of the greater trochanter, corresponding to 50% of the height of its central vertical axis, as well as I2, which corresponds to the most central point of the ilium, representing 50% of the height of the most caudal portion of its body. The isometric point found by us details the exact location of perforation in all aspects (height and length), both in the ilium and the trochanter. In addition, it is a personalized point created for each patient from its radiographic examination and taking into consideration its anatomical variations, so that there is no damage to the suture during hip extension and flexion movements.