Closed Hip Reduction Technique

Re: Closed Hip Reduction Technique

Christina Smith — Sun, 12 Oct 2014 00:10:27 GMT

Most hip dislocations are a source of joy,the rest are very frustrating, no books or bottles ever used but maybe the failures would have benefited. I love them because they clunk back in and symmetry is re-established .. If the dogs have good hips they can walk out virtually sound. Shallow hips can also be satisfying even if they don't look good radiographically,extended hd xrays can confuse the picture so always, always use a frog picture to confirm. Cats- hmmm

Re: Closed Hip Reduction Technique

Michael Woodhouse — Sat, 11 Oct 2014 23:47:09 GMT

Evelyn - I can provide you with an empty calcium bottle FOC if you think it will help?

Re: Closed Hip Reduction Technique

Evelyn Barbour-Hill — Sat, 11 Oct 2014 23:26:55 GMT

I'm not an orthopaedist but I cannot see the point of hitting the greater trochanter with a book or anything else.

Moreover, to do this to a book constitutes gross abuse of book. Criminal.

Re: Closed Hip Reduction Technique

karen jones — Sat, 11 Oct 2014 20:56:57 GMT

[quote user="Thomas Johnson"]

[quote user="Martin Atkinson"]

The wacking with a bit book thing may well be to displace the joint capsule remnants as well. Basically lay the animal on the opposite side with a bit of padding underneath, slightly abduct the affected limb so it is parallel with the table and wack the trochanter with your Encyclopaedia Britannica or whatever using just the weight of the book rather than any force. A book is nice rather than a mallet as it has a bit of give in it.

[/quote]

I saw one of these as a student, and after the hip had gone back in the vet said it needed CMPD therapy and disappeared out of the room, when he came back he had a 400ml bottle of calcium, magnesium, phosphate and dextrose which he used to hit the greater trochanter!

[/quote] We also use a glass calcium bottle on reduced hip luxations, understood this was because the bottle would break before we do too much damage but then we also are dinovets ie qualified over 30 years........

Re: Closed Hip Reduction Technique

scatty — Sat, 11 Oct 2014 17:33:44 GMT

I am so glad that no one else likes Ehmer slings - tried to put one on a cat this week then abandoned and took it off before I woke the cat up because I thought it looked a bit 'Guantanamo Bay' - esque!

Interesting that people put pressure on the greater trochanter with a book. I have not done this before but I also tend to get quite a few which pop out again and go on to need surgery. I have a yorkie booked in to do an FHNE next week (has been seen at another vets and had several attempts at closed reduction; now owner has run out of funds and needs a last chance solution). Any surgical tips? (e.g do people still like using osteotomes ) or approaches hints/tips? Has anyone had any complications with nerve damage afterwards and how to avoid?

Re: Closed Hip Reduction Technique

Martin Atkinson — Wed, 08 Oct 2014 11:07:38 GMT

[quote user="bob lehner"]I always thought I was alone in thinking the Ehmer sling a fairly bizarre and pointless item. [/quote] As you may have gathered from my posts, I don't exactly lack in self belief. You should follow the Atkinson doctrine that if you've thought something through carefully and you think it is right (or wrong in this case) even if the whole world tells you the opposite you're still right so it doesn't matter if you're the only one.

I actually heard that they use the Ehmer sling as a means of torture in Guantamano Bay after water boarding, sleep deprivation and electrodes to the testicles have failed.

Re: Closed Hip Reduction Technique

Mark Hedberg — Wed, 08 Oct 2014 10:46:32 GMT

[quote user="bob lehner"]

Why is it perpetuated in the text books ?

[/quote]

It's that newfangled eminence based medicine, some professor liked it in the 1920s I expect!

Re: Closed Hip Reduction Technique

bob lehner — Wed, 08 Oct 2014 10:27:38 GMT

[quote user="Martin Atkinson"][quote user="Malcolm Ness"]I haven't used an Ehmer sling this century.[/quote] I'm glad you said that Malcolm, all they ever done for my cases in the past is cause discomfort and rub sores so I also gave up a long time ago.[/quote]

I'm delighted to read these comments as I always thought I was alone in thinking the Ehmer sling a fairly bizarre and pointless item.

No-one can ever remember how it is supposed to be configured without referring to the book, then it generally falls off, or is too tight - and it must be desperately uncomfortable to have your leg held in extreme forced flexion for days on end.

Why is it perpetuated in the text books ?

Re: Closed Hip Reduction Technique

Hannah Wynne Richards — Wed, 08 Oct 2014 09:39:01 GMT

I wish I could apply a sling. My problem is the dog who walks home OK,then comes back in 24/48 hours when it's re-dislocated.

Wynne

Re: Closed Hip Reduction Technique

Hannah Wynne Richards — Wed, 08 Oct 2014 09:34:41 GMT

Another who's never managed to apply an effective sling.

Wynne

Re: Closed Hip Reduction Technique

Anthony Dennison — Wed, 08 Oct 2014 09:18:41 GMT

[quote user="Evelyn Barbour-Hill"]

I was dealing with a fresh dislocated hip and we had a work experience pupil with us. So I told him "You can help me here. Hold that, pull there and push here, while I manipulate the femoral head back in."

So he pulled there and pushed here, and before I'd laid a finger on the patient there was a click and the job was done.

[/quote]

That's how I've put the 2 I've done back in - pulled the affected limb caudally, adducted and applied some external rotation. Both went in ok.

Re: Closed Hip Reduction Technique

Anthony Dennison — Wed, 08 Oct 2014 09:16:44 GMT

[quote user="Malcolm Ness"] I haven't used an Ehmer sling this century.[/quote]

Good to know. I did put one on this dog but it was a right bloody kerfuffle; it was a patterdale so the femur was so small the damn thing kept slipping off! Won't be doing those again.

Re: Closed Hip Reduction Technique

Mark Hedberg — Wed, 08 Oct 2014 09:14:32 GMT

[quote user="Evelyn Barbour-Hill"]

He was well chuffed.

[/quote]

I'd be rather pleased too! :)

Re: Closed Hip Reduction Technique

Martin Atkinson — Tue, 07 Oct 2014 19:08:52 GMT

[quote user="Bob Russell"]Problem is my Sissons is an ebook so lets hope I don't get a similar case[/quote]I don't know, a computer would do a good job - best use a laptop though.

Re: Closed Hip Reduction Technique

Bob Russell — Tue, 07 Oct 2014 17:29:39 GMT

Another one told to hit it with a book. Pretty sure it was Sissons but after all these years cannot find which book from the original notes!

Problem is my Sissons is an ebook so lets hope I don't get a similar case!

Re: Closed Hip Reduction Technique

Martin Atkinson — Tue, 07 Oct 2014 17:23:02 GMT

[quote user="Malcolm Ness"]I haven't used an Ehmer sling this century.[/quote]I'm glad you said that Malcolm, all they ever done for my cases in the past is cause discomfort and rub sores so I also gave up a long time ago.

Re: Closed Hip Reduction Technique

Malcolm Ness — Tue, 07 Oct 2014 16:13:21 GMT

I confess to doing the book-bashing thing post reduction. Not sure it does any good but that is the way I was taught. If anything, it might make the periarticular muscles spasm and help hold the hip in place. There is rarely, if ever a blood clot in the joint based on my experience in dealing with open reductions.However, the torn end of the trees ligament is usually remarkably swollen to the extent that it stops the femoral head seating properly in the acetabulum. Occasionally, flaps of torn joint capsule interpose themselves and lead to instability/reluxation. Capital fractures or ace tabular fractures make successful closed reduction unlikely, though not always impossible.

My approach to closed reduction involves taking rads before you start (3 views, lateral, VD frog-leg plus VD extended hips) to confirm the direction of luxation and perhaps more importantly, to see if there are any femoral head or acetabular fractures. Cranio-dorsal laxations are way the most common and much the easiest to deal with. Cats are easy to reduce - a combination of traction, rotation and spatial awareness puts the hip back in place. For dogs, the same applies but a deal of intelligently applied strength is required. With the dog anaesthetised and in lateral recumbency, I pass a rope/dog leash or similar under the affected limb and secure it to the table leg some way cranial to the front of the pelvis. The other end of the rope is held caudally and low such that the "strain" is in contact with the venture of the pelvis. This allows traction to be applied on the lower part of the luxated leg such that the femoral head can be returned into place. I don't ever use DeVita pins and I haven't used an Ehmer sling this century.

If the hip reluxates, you can try to repeat closed reduction but the chances of it staying in are lower. My next step is open reduction through a standard, crania-lateral approach with debridement of the teres ligament etc and repair of the joint capsule. I rarely need to use toggles or other retaining/restricting hip sutures or imbrications.

Re: Closed Hip Reduction Technique

Thomas Johnson — Tue, 07 Oct 2014 14:47:19 GMT

[quote user="Martin Atkinson"]

[/quote]

Re: Closed Hip Reduction Technique

Hannah Wynne Richards — Tue, 07 Oct 2014 11:03:44 GMT

Sissons - swot up your anatomy 1st, then use the book to whack the joint!

Wynne

Re: Closed Hip Reduction Technique

Martin Atkinson — Tue, 07 Oct 2014 10:14:42 GMT

[quote user="Anthony Dennison"]Could you expand on this further[/quote]Not sure which bit you want me to expand on. But first when you take your check X-ray do it lateral or D/V with the cat in a 'frog leg' position so it doesn't risk re-dislocating.

The wacking with a big book thing may well be to displace the joint capsule remnants as well. Basically lay the animal on the opposite side with a bit of padding underneath, slightly abduct the affected limb so it is parallel with the table and wack the trochanter with your Encyclopaedia Britannica or whatever using just the weight of the book rather than any force. A book is nice rather than a mallet as it has a bit of give in it.

Alternatively if this sounds too Dinovet follow Eyelyn's advice.

Re: Closed Hip Reduction Technique

Evelyn Barbour-Hill — Tue, 07 Oct 2014 01:45:18 GMT

Anecdote.

So he pulled there and pushed here, and before I'd laid a finger on the patient there was a click and the job was done.

No, I didn't pretend that the joint was still out and a magic manipulation from me was still required.

He was well chuffed. I mentioned the incident on his report.

Re: Closed Hip Reduction Technique

Evelyn Barbour-Hill — Tue, 07 Oct 2014 01:22:59 GMT

[quote user="Martin Atkinson"]I'm not sure how I do them, its bit like reversing a car with a trailer its just instinctive, from an X-ray I can envisage where it is and where it needs to go. I just wiggle them until they're in. Always do a check X-ray to show its reduced even if you're sure then (and here comes the dinovet bit)...wack it with a big book to squash out any clots - at least that's the theory![/quote]

. Yeah. Or press down on the greater trochanter while flexing and extending a good few times. More scientific.

Visualise the anatomy and what you're trying to do: it works for me.

[quote user="Anthony Dennison"]The reading I've done suggests that with craniodorsal luxations there will be some joint capsule remnants in the acetabulum which will increase the risk of re-luxation.[/quote]

Well, yes, but if you've got it back in, there's no point in worrying right then – is there?

I reckon you can tell by the feel of it going back in whether you're going to need to do anything else, (like that ghastly figure of eight Elastoplast thing for instance.)

Re: Closed Hip Reduction Technique

Anthony Dennison — Mon, 06 Oct 2014 19:39:53 GMT

[quote user="Martin Atkinson"]Always do a check X-ray to show its reduced even if you're sure then (and here comes the dinovet bit)...wack it with a big book to squash out any clots - at least that's the theory![/quote]

Could you expand on this further? The reading I've done suggests that with craniodorsal luxations there will be some joint capsule remnants in the acetabulum which will increase the risk of re-luxation.

Re: Closed Hip Reduction Technique

Martin Atkinson — Mon, 06 Oct 2014 19:30:07 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Anthony Dennison"]Which way is correct, or is it just a case of which ever way works to get the hip back in?[/quote]

The latter.

Personally I like to use both thumbs on the greater trochanter.

[/quote]I'm not sure how I do them, its bit like reversing a car with a trailer its just instinctive, from an X-ray I can envisage where it is and where it needs to go. I just wiggle them until they're in. Always do a check X-ray to show its reduced even if you're sure then (and here comes the dinovet bit)...wack it with a big book to squash out any clots - at least that's the theory!

I feel a red star coming on.

Re: Closed Hip Reduction Technique

Evelyn Barbour-Hill — Mon, 06 Oct 2014 19:20:54 GMT

[quote user="Anthony Dennison"]Which way is correct, or is it just a case of which ever way works to get the hip back in?[/quote]

The latter.

Personally I like to use both thumbs on the greater trochanter.