Judul : Teknik Operasi dan Reposisi Luksasi Coxofemoralis pada Hewan (Bedah Fraktur)
link : Teknik Operasi dan Reposisi Luksasi Coxofemoralis pada Hewan (Bedah Fraktur)
Teknik Operasi dan Reposisi Luksasi Coxofemoralis pada Hewan (Bedah Fraktur)
definition
A dislocation of the hip joint is an anomaly in which the head of the femur protrudes from the acetabulum. A dislocation causes pain in the hip joint, lameness and even paralysis of the hind limbs. Dislocation of the hip joint is common in small animals, especially dogs.
A dislocation causes pain in the hip joint, lameness and even paralysis of the hind limbs, depending on the severity of the dislocation. German Shepherds, Golden Retrievers and Siamese cats are prone to this disease.
Treatment of a dislocated hip should be accelerated as more severe injury occurs. For this reason, animals with disruption in this area require intensive treatment and care.
In this case, the 4R processing system comes into play, namely detection, repositioning, retention and rehabilitation. Measures to be taken in the treatment of cases of dislocation of the hip joint by closed and open reduction. The prognosis in this case depends on the severity of the disruption (Harasen 2005). The purpose of this operation is to improve the condition of the animal for the better.
hip joint
The hip joint is a cup-shaped joint formed by the head of the femur and the acetabulum.
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| Normal hip position |
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| X-ray examination of hip dislocation in dogs |
Treatment of dislocation of the hip joint
Treatment of dislocation of the hip joint consists of 2 types, namely:
1. Open reduction / with surgery
2. Closed reduction / without surgery
Both types of hip dislocation treatment are used depending on the severity of the hip dislocation itself.
Open reduction / with surgery
A. Before the operation
Some of the preparations that need to be made before starting the surgery include:
1. Patient preparation, consisting of a physical examination and diagnosis of the patient (animal).
2. Equip the instruments and materials required during the operation.
3. Represent the operating room
B. Surgical technique
- The standard approaches for surgical treatment of dislocation are the lateral cranial approach to the hip joint and the trochanteric osteotomy approach. Sometimes a caudal approach to the hip joint is used.
- Step 1: A longitudinal skin incision is made along the craniolateral border of the femur and continues proximally through the greater trochanter.
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| Leather engraving |
- The tensor fascia lata is then dissected slightly cranially, sometimes the tendon of the insertion of the deep gluteal muscle is dissected to facilitate visualization of the circumflex femoral vein.
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| Visible muscles |
- M. gluteus profundus is dissected and then exposed dorsally and caudally. The vastus lateralis is then stretched distally so that the joint capsule is exposed.
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| Strengthening of M. gluteus profundus and M.vastus |
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- The joint capsule is cut with a scalpel in a T shape. 15. A T-shaped incision is made at the distal end.
- Removes scars around ligaments and joints.
- Drill two parallel holes with a diameter of 1.6 mm with a Kirschner wire through the greater (slightly proximal) trochanter caudal to the cranial direction.
- Another drill ventral to the ilium, cranial to the acetabulum, distomedial to proximal.
- Stitched with loop thread 8 through the iliac foramen and through two holes of the greater trochanter without cutting the nerve. Depending on the size of the animal, several stitches can be sewn into the same hole with a buttonhole thread.
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| . Seam to the hip joint |
- Work capsular connections with crusaders.
- Tie the ends of the threads of the sling with a roller knot as the seat legs are pulled in and turned inwards.
- Gluteal Tenotomy Correction
- Suture of the fascia, subcutaneous tissue and skin with interrupted sutures
C. Postoperative care
- The cut/cut scar should be kept clean.
- Restriction of movement of animals through cages
- Check the dressing and check daily for bad odor, swelling and pressure on the developing wound.
- Prescribe antibiotics to prevent infection.
- Provide good nutrition to support the recovery process.
- Bandages and sutures were removed after 7 days, depending on how the healing took place.
Closed reduction / no surgery
A. Before the operation
Some of the preparations that need to be made before starting the surgery include:
- Patient preparation consisting of physical examination and diagnosis of the patient (animal)
- Completion of tools and materials needed for work.
- Operating room preparation
B. Surgical technique
This method of closed reduction can be performed in several steps:
- Step 1.
The animal is first anesthetized and placed in a lateral position with the limb elevated and the bandage on the upper side. A rope or towel is placed in the groin area and gently pulled on the dorsal side. The distal part is fixed and slowly retracted to the left.
The tissue can be pulled to stretch the joint, and if necessary, this can be done for a while to allow the femoral head to return to a position parallel to the acetabulum.
- step 2
At this point, one hand is placed on the greater trochanter (femoral region) while the other hand holds it distally. The hip joint can then be repositioned by rotating the outer limb and maintaining the position.
The femoral head is then placed on the acetabulum with a fixed point on the greater trochanter and strongly pushed in the opposite direction in the area of the greater trochanter, where this movement allows the femoral head to pass to a normal ligament with the acetabulum. to call ligaments in the second direction.
- step 3
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| Rotary Press Parts |
If the displacement of the joint has decreased, try to press the trochanter, and this movement can help to move the tissue and reduce the formation of an acetabular hematoma. Where to look for a decrease in displacement can be seen from:
- Palpation of parts (iliac crest, ischial tuberosity and greater trochanter)
- Measurement of the distance between the greater trochanter and ischial tuberosity
- leg length recovery
- step 4
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| Joints make different movements |
At this stage, the movements are performed in several (main and external rotations) to perform the hip adduction movement. where ehmer belts are still used today.
- step 5
At this point we temporarily take the elastic bands, use these bands of the metatarsal bones (including the soles) on the back long enough to be in a bent position.
- step 6
Application of the Ehmer bandage began with a plaster cast around the metatarsals, followed by the addition of several rubber bands starting at the distal foot and ending at the proximal dorsal edge. The limb should be strongly flexed and pressed against the greater trochanteric region, as the limb is abducted when the dressing is applied.
- step 7
The sole of the foot is formed distally by an elastic that grips the medial thigh through the groin and back. On the fingers it is necessary to make gaps of the same size.
- step 8
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| Prose Placement Strip. one |
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| Prose Placement Strip. 2 |
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| Prose Placement Strip. 3 |
the process of applying the strip to its stable curved position (usually 3-5 strips of elastic). The elastic bands located distally should also be attached along the metatarsals. This can help reduce the likelihood of distal end swelling and swelling.
- step 9
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| Emer strengthens the dishes |
To reinforce the Ehmer bandage and help manage repositioning by rotating the lateral ankle, use the Elastikon strip that starts at the metatarsals, goes around the back and abdomen, and ends behind the abdominal strap.
- step 10
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| Emer's use of the catapult |
After proper use of the Ehmer sling, the use of orthogonal radiographs is necessary to show that the hips are normal. In the final stages, appropriate measures are required to ensure that the limb is in the correct position for rotation.
- step 11
In anterior dislocation, the femoral head can be manipulated by applying pressure to the lateral side and cranial trochanter with one hand and retracting the ischium into the acetabulum with the other hand. When palliative measures stabilize, immobilize the hind limb for 10 days to allow sufficient time for soft tissue formation.
C. Postoperative care
- The cut/cut scar should be kept clean.
- Restriction of movement of animals through cages
- Check the dressing and check daily for bad odor, swelling and pressure on the developing wound.
- Prescribe antibiotics to prevent infection.
- Provide good nutrition to support the recovery process.
- Bandages and sutures were removed after 7 days, depending on how the healing took place.
Compound:
R. Hõim, e tutti, 2003. Use of a modified pin activation technique for the treatment of hip dislocations in dogs: a literature review and two case reports.
taguchi Kiyoshi et al., 2011. Ultrasound pattern of bovine hip dislocation in different directions. Doctorate in Veterinary Science and Technology: 003. doi: 10.4172/2157-7579.S3-003.US
Daniele, 2012. Report on the treatment of sacroiliac and hip dislocations in cats after a motor vehicle accident. Comfortan, Eurovet Animal Health Ltd. Cambridge, United Kingdom
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