Modified toggle pin technique combined with prosthetic capsular reconstruction for surgical stabilization of coxofemoral luxation in a Shetland pony

Abstract

Objective To describe open reduction and surgical stabilization of a coxofemoral luxation in a pony using a modified toggle pin technique and prosthetic joint capsule reconstruction without osteotomy of the greater trochanter. Animal A 2-year-old Shetland pony with a bodyweight of 167 kg. Study design Case report. Methods Radiographic examination confirmed craniodorsal luxation of the left coxofemoral joint. An open reduction with the aid of a pulley system was performed. A toggle pin was inserted through a bone tunnel extending from the level of the femoral shaft through the femoral head and the center of the acetabulum for the pin to be positioned on the medial wall of the acetabulum. FiberWire was subsequently passed through the cranial and caudal aspects of the acetabulum as well as a transverse tunnel in the femoral neck in a figure of 8 to facilitate capsular reconstruction. The pony was placed in a sling for 8 weeks and gradually returned to normal activity over 2 months. Results Postoperative radiographic examination confirmed the position of the femoral head in the acetabulum with the implants in place. On 2-year follow-up the pony was sound at walk and trot. Conclusion A combined intra-and extra-articular stabilization technique for coxofemoral luxation in a pony resulted in successful long-term reduction and excellent outcome.

Computer‐assisted surgery for placing toggle constructs across the coxofemoral joints of small equids using a minimally invasive approach–A proof‐of‐concept cadaveric study

“…Braided ultrahighmolecular-weight polyethylene suture materials have been used for coxofemoral luxation repair in small animal surgery with favorable success rates, 16 and in a single pony treated with a combination of a modified toggle pin technique and prosthetic capsular reconstruction. 11 However, the present study does not provide data that would indicate that the type of prosthesis used is adequate for clinical use. Hence, further research is needed to assess the biomechanical suitability and the required tension of such toggle constructs for the use in small equids.…”

“…The strength, stability and required tension of the toggle construct are unknown. Braided ultrahigh‐molecular‐weight polyethylene suture materials have been used for coxofemoral luxation repair in small animal surgery with favorable success rates, 16 and in a single pony treated with a combination of a modified toggle pin technique and prosthetic capsular reconstruction 11 . However, the present study does not provide data that would indicate that the type of prosthesis used is adequate for clinical use.…”

“…10 Techniques that combine extra-articular stabilization with a toggle construct to provide additional stability have been described. 10,11 Unfortunately, regardless of the surgical technique, failure of fixation following successful open reduction and surgical stabilization appears to be common. 2 Repeating the placement of the toggle construct with extra-capsular stabilization, femoral head ostectomy 12 or total hip arthroplasty 13,14 are the options to salvage an affected small equid.…”

“…Techniques for extra‐articular stabilization have been described, including a prosthetic capsule technique 9 and a synthetic capsular reconstruction, with or without transposition of the greater trochanter 10 . Techniques that combine extra‐articular stabilization with a toggle construct to provide additional stability have been described 10,11 . Unfortunately, regardless of the surgical technique, failure of fixation following successful open reduction and surgical stabilization appears to be common 2 .…”