Page 2340 - Cote clinical veterinary advisor dogs and cats 4th

1158 Reduction (Closed): Shoulder, Elbow, or Hip

• The depressor is held in a gloved hand to • Gentle smears are made from the material Alternatives and Their
the length of an outstretched index finger. gathered during the scraping. Try to minimize Relative Merits
the amount of lubricant that contaminates
• Noninvasive fecal flotation or examination
VetBooks.ir • Lubricant is applied to the finger but not • Slides are processed for cytologic examination of direct fecal smear may detect intestinal
If the depressor has been broken, the finger
the slide.
should cover the roughened edge.
parasites responsible for large-bowel signs.
to the tongue depressor.
in a routine fashion.
intact architecture but requires general
• The finger and depressor are inserted approxi- • For animals with extremely friable rectal • Tissue biopsy provides larger samples with
mately 2 inches (5 cm) into the rectum. tissue or for very small animals, a cotton- anesthesia and bowel cleansing.
• The finger is used for applying gentle but tipped applicator can be used in place of • Serologic tests with varying sensitivity and
firm pressure to the tongue depressor while the tongue depressor. specificity are available for histoplasmosis
making two to three sweeping motions cover- and pythiosis.
ing 20%-50% of the circumference of the Postprocedure
rectum. Special care is not required afterward, but the AUTHOR: Leah A. Cohn, DVM, PhD, DACVIM
• The gloved finger and tongue depressor are animal should be monitored for worsened EDITOR: Mark S. Thompson, DVM, DABVP
removed. pain or systemic signs that may indicate rectal
• The edge of the tongue depressor is scraped perforation.
against a microscope slide.
Reduction (Closed): Shoulder, Elbow, or Hip Client Education
Sheet

Difficulty level: ♦♦ • Assistant • When hanging the forelimb to help with
• Bandage material elbow luxation reduction, be sure to secure
Synonyms the limb proximal to the metacarpi and
Coxofemoral luxation (hip); dislocated shoul- Anticipated Time use a thick, soft rope (or roll gauze) in a
der, elbow, or hip; scapulohumeral luxation About 10-30 minutes double-loop technique to distribute pressure
(shoulder) evenly on the distal limb. These measures
Preparation: Important reduce the risk of iatrogenic damage.
Overview and Goals Checkpoints
• Severe joint trauma can cause ligament/joint • Advise owner of aftercare and possible Procedure
capsule damage, resulting in displacement drawbacks: All luxation reductions are performed with
of the bones of a joint. ○ Recurrence the animal under general anesthesia and in
• Closed reduction aims to restore the normal ○ Degenerative joint disease lateral recumbency, with affected side up
alignment of the joint without surgical ○ Decreased range of motion (nondependent).
intervention and to maintain stability until ○ Possible need for open reduction • Shoulder
these soft tissues heal. ○ Postreduction bandage care ○ Forelimb held in extension (in a ventral
○ Postreduction exercise restriction direction perpendicular to the long axis
Indications After anesthetic induction: of the body, as in the standing animal)
• Traumatic luxation of normal shoulder, • Minimum of two views of the joint to ○ For lateral luxation of the humeral head,
elbow, hip joints (pp. 291, 472, and 913) confirm luxation versus fracture apply medial pressure to the head at the
• Acute luxation (<5 days) • Animal in lateral recumbency, affected limb same time as lateral pressure on the scapula.
up (affected limb on the nonrecumbent side) ○ Check range of motion and stability.
Contraindications • Hanging the affected limb can be useful ○ Place leg in a spica splint.
• Luxation associated with severe ligament (elbow luxation) for 5-10 minutes. Secure ○ For medial luxation of the humeral head,
damage or avulsion fractures that impede the carpus, and hoist the limb vertically with apply lateral pressure to the head at the same
normal joint function and/or leave the joint traction. Be sure to secure the limb proximal time as medial pressure on the scapula.
unstable after closed reduction to the metacarpi and use a thick, soft rope ○ Check range of motion and stability.
• Failure of closed reduction due to inter- (or roll gauze) in a double-loop technique, ○ Place the leg in a Velpeau sling.
posed soft tissue, hematoma, or recurrent rather than a single loop, to distribute pres- ○ Splint or sling can be removed after 2
luxation necessitates open (surgical) sure evenly on the distal limb. These measures weeks.
reduction. reduce the risk of iatrogenic damage. ○ Passive range-of-motion exercises can
• Chronic luxation (>5-7 days) begin after bandage removal, but restricted
• Dysplastic joint Possible Complications and exercise is essential for another 2-4 weeks.
○ Glenoid dysplasia Common Errors to Avoid • Elbow
○ Total hip replacement may be a better • If there is excessive instability after closed ○ Radius and ulna are usually luxated later-
option in cases of severe hip dysplasia. reduction, open reduction should be ally relative to the distal humerus.
• Femoral head and neck ostectomy (FHO) performed. ○ With the elbow in flexion, inwardly rotate
may be an acceptable alternative to • Failure to critically evaluate plain radiographs the antebrachium.
closed/open hip reduction in a small dog to assess joint anatomy or damage, avulsion ○ Combined with elbow flexion, this
or cat. fragments and intraarticular debris movement enables the anconeal process
• Trying to reduce a luxation with sedation of the ulna (caudal-most extent of the
Equipment, Anesthesia alone trochlear notch in the ulna) to hook into
• General anesthesia • Failure to appropriately bandage the luxation the olecranon fossa of the humerus. This
• Rope or leash to provide counterpressure • Removal of bandage too soon maneuver is followed by careful extension
(hip luxation) • Inadequate patient exercise restriction of the elbow.

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