Authors of section

Author

Tomas Guerrero

Executive Editor

Amy Kapatkin

General Editor

Noel Moens

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Fragment removal

1. Principles

Small fragments not amenable for fixation should be removed to avoid damaging the articular surface. In most cases, the hip joint luxates while the fragment remains attached to the ligament of the head of the femur.

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2. Patient positioning

This procedure is performed with the patient in either lateral recumbency....

lateral recumbency position

3. Approach

This fracture may be exposed using a craniolateral approach.

fragment removal

4. Surgical technique

Fragment removal

After thorough exploration of the coxofemoral joint, small fragments not amenable for fixation are removed.

fragment removal

Closure

In most cases, joint stabilization will be required following fragment removal and reduction of the luxation. A capsulorrhaphy as well as a variety of other techniques can be performed to maintain reduction until the joint capsule heals. See other resources for surgical techniques for traumatic hip luxations.

5. Aftercare

Activity restriction is indicated until evidence of bone union is detected on radiographic examinations.

Implants may cause discomfort of the adjacent soft tissue. If this occurs, implants are removed after radiographic evidence of bone healing is complete. In case of infection, implants must be removed after complete bone healing.

Phase 1: 1-3 day after surgery

Aim is to reduce the edema, inflammation, and pain.

Integrative medical therapies, anti-inflammatory and analgesic medications.

Phase 2: 4-10 days after surgery

Aim is to resolve the hematoma, edema and control pain, and prevent muscle contracture.

Anti-inflammatory and analgesic medications may still be needed. Rehabilitation and integrative medical therapies can be used.

Special attention should be given to patients less than 1 year of age with a femoral fracture. Rehabilitation is strongly recommended to help prevent quadriceps muscle contracture.

If the dog is not starting to use the limb within a few days after surgery, a careful evaluation is recommended.

10-14 days after surgery the sutures are removed.

Radiographic assessment is performed every 4-8 weeks until complete bone healing is confirmed.

Robinson and Ehmer slings

After transecting the ligament of the femoral head for visualization, capsulorrhaphy is carefully performed for stability. Additional stabilization of the hip joint is generally required (see other resources for surgical techniques).

If after surgical treatment additional stability is required or the internal stabilization must be protected, a Robinson (A) or an Ehmer (B) sling may be applied.

This Robinson sling allows for a wide range of motion of the pelvic limb but prevents full weight bearing and full extension of the limb.

The Ehmer sling is used to slightly abduct and internally rotate the head of the femur. It restricts more mobility than the Robinson sling.

These two slings must be carefully monitored after application to avoid complications such as skin irritation, abrasions, swelling of the foot, and slippage of the sling.

Further information on the correct application of these slings can be found in the literature.

fragment removal

Implant removal

If there is no implant failure or infection, there is no need for implant removal.