Small animal veterinary case study - canine coxofemoral luxation

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Case study

History
The patient was a 6-year old, 19kg, female spayed, Boykin spaniel with a history of being involved in a road traffic accident approximately 30 minutes prior to initial presentation at the practice.

Clinical signs
The patient was ambulatory upon arrival and she was quiet, alert and responsive.
Rectal temperature was 38.2°C. Oral mucous membranes were pink and tacky with a capillary refill time of approximately 3 seconds. Heart rate was 120 beats per minute with no cardiac murmurs or adventitious lung sounds apparent on thoracic auscultation. The femoral pulses were palpably strong bilaterally with no pulse deficits.

Numerous contusions and abrasions were observed on the ventral abdomen. The patient voluntarily passed approximately 300ml of normal urine. Severe discomfort was elicited on movement of the left hindlimb. The patient was non-weight bearing on the left hindlimb and the stifle was rotated externally. No abnormalities were detected on digital rectal examination.

Investigation
Due to financial limitations of the client, further diagnostic evaluation was kept to a minimum. Radiography of the pelvis was performed to evaluate suspected traumatic orthopaedic disease. Orthogonal views (Radiograph 1 - right lateral; and Radiograph 2 - ventrodorsal) of the pelvis were obtained.


The radiographs are of diagnostic quality with good patient positioning, collimation to the areas of interest and adequate exposure however a right/left marker is not present.
The primary radiographic abnormality observed on both views is left coxofemoral luxation. The left femoral head is displaced craniodorsally. There are no apparent fractures involving the pelvis, femur or lumbar/coccygeal vertebrae. There is faecal material present in the descending colon/rectum.

Radiography was essential in this case to rule out the presence of possible differential diagnoses such as pelvic or femoral fractures.

Diagnosis
The radiographic findings are consistent with the history and clinical examination findings of a traumatic left coxofemoral luxation.

Treatment/procedure
Treatment options were discussed with the owner for treatment of left coxofemoral luxation including closed reduction and external stabilisation as well as referral for open reduction and internal stabilisation.

The possibility of repeated luxation/subluxation following closed reduction was also discussed with the owner. The owner declined referral due to financial considerations and opted for closed reduction under general anaesthesia.

The patient was placed under general anaesthesia, a closed reduction of the left hip was performed and an Ehmer sling was placed. The patient was discharged with analgesia and instructions for restricted exercise with a recheck in 5 days or earlier if clinically indicated.
At the 5 day recheck, the left coxofemoral reduction was deemed unstable, likely secondary to excessive patient activity as a result of poor owner compliance.

Alternative treatment options were discussed including referral for open reduction and stabilisation which the owner again declined due to financial considerations. Thus, femoral head and neck excision was offered as a salvage procedure to provide the patient with an improved quality of life while preserving the limb and the owner consented.

The patient was placed under general anaesthesia and a femoral head and neck ostectomy (FHO) of the left femur was performed. An immediate post-operative, ventrodorsal radiograph (Radiograph 3) of the pelvis was performed to ensure adequate excision of the femoral neck had been performed and to also provide documentation of the surgical procedure.


The radiograph is of adequate exposure with good patient positioning and collimation to the region of interest however a left/right marker is not present.

The primary radiographic finding is an adequate surgical excision of the left femoral head and neck. The margins of the ostectomy site are relatively smooth. There is a small, free-floating fragment of bone present radiographically in the region of the ostectomy site and the lesser trochanter. This fragment is considered to be of little clinical significance. No further radiographic abnormalities are observed.

Outcome
The patient recovered without further complications and within 3 months, the patient returned to normal use of the limb with full ambulation and no evidence of discomfort.

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