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On: 07 May 2014, At: 07:49
Publisher: Taylor & Francis
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Veterinary Quarterly
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Clinic for Zoo Animals, Exotic Pets and Wildlife, Vetsuisse Faculty, University of Zurich,
Zurich, Switzerland.
Accepted author version posted online: 18 Mar 2014.Published online: 02 May 2014.
To cite this article: Panagiotis N. Azmanis, Morena B. Wernick & Jean-Michel Hatt (2014): Avian luxations: occurrence,
diagnosis and treatment, Veterinary Quarterly, DOI: 10.1080/01652176.2014.905731
To link to this article: http://dx.doi.org/10.1080/01652176.2014.905731
REVIEW ARTICLE
Avian luxations: occurrence, diagnosis and treatment
Panagiotis N. Azmanis*, Morena B. Wernick and Jean-Michel Hatt
Clinic for Zoo Animals, Exotic Pets and Wildlife, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
1. Background
The word luxation derives from the Latin word luxare
which means to dislocate. Luxation or dislocation is the
abnormal displacement of a bone from a joint. A partial
dislocation is called a subluxation.
In most avian species luxations occur infrequently
compared to other orthopedic conditions (Martin &
Ritchie 1994). A study revealed that 1 in 10 birds, presented with wing or shoulder girdle fracture, was also
accompanied by a respective luxation (Schuster &
Krautwald-Junghanns 1996). The most commonly
affected avian taxonomic groups are psittacines, small
cage birds, raptors, pigeons, and waterfowl. These are presented to the avian practitioner as companion birds, wildlife casualties, falconry birds, or residents of a zoological
collection. Additionally, luxations are a frequent problem
in commercial broiler farms due to excessive weight gain
over a short period (Duff 1985). Although diagnosis of a
luxation typically does not pose a big challenge, the prognosis in many types of luxation remains poor to guarded.
The aim of this article is to review current knowledge
of avian luxation, its diagnosis and treatment, with a view
to understanding why the prognosis remains poor. The
review concludes with recommendations to optimize
future research.
2. Methods
The literature review was conducted using the keywords
avian, bird, luxation, dislocation, articulation, joint,
palatine bone, spinal, cervical, thoracolumbar,
*Corresponding author. Email: azmanis.vet@gmail.com
2014 Taylor & Francis
The majority were Falconiformes (30%) and Psittaciformes (25%) followed by the order of Apodiformes
(swifts, swallows, 16%). Columbiformes were not
present (Figure 3).
3. Results
3.1.
3.2.
Veterinary Quarterly
Figure 3. Avian orders and luxation incidents as represented in the published literature (19762013) (n 105 incidents) and in UZH
(20012011) (n 67 cases).
Table 1. Overview of the etiology and clinical manifestation of luxations as referred in the literature.
Articulation
Etiology
Metacarpophalangeal Trauma
Floppy wingtip
Carpal
Elbow
Proximal coracoid
Collision
Scapulohumeral
Clinical manifestation
Palatine bone
Spine
Coxofemoral
Femorotibial
Intertarsal
Metatarsometatarsal
Flight inability
Inability to gain height
Crepitus
Rupture of the tendon of the supra- None referred
coracoideus muscle, leading to
upward subluxation of the
humeral head.
Acute head trauma
Hyperextended rhamphotheca
Simultaneous act of a dorsal force
with maxillary hyperextension
Trauma (gunshot, collision)
Poor flight performance
Improper handling (falconry)
Unilateral or bilateral leg paresis
Paralysis
Brainstem compression due to
Balance equilibrium, hard landing
trauma
Release effort of an entangled foot Fixed extension of the leg
Improper handling
Instability
Trauma
Crepitus
Contorted position of the affected
leg. Unable to stand
Lateral torsion of the leg. Unable to
stand
Stretching leg backwards
Developmental abnormality
Joint hyperextension
Spotaneous orthopedic disease
Positive withdrawal sign
Trauma (gunshot, collision,
Medial or lateral instability
inadequate leash in falcons)
Improper training (falconry)
Absence of palpable fracture
Landing inexperience (falconry)
Lack of crepitus
Non-weight-bearing lameness
Firm swelling
Ability to partially reduce the
tibiotarsus into its normal
position
Trauma
Tarsometatarsal rotation
Developmental rupture of tibial
Persistent ligamentous laxity
cartilage
Avulsion of M. flexor hallucis
Joint swelling
longus tendon
Entangled in net sealing, tendon
Palpation of the tendon of M. flexor
rupture
hallucis longus
None referred
No ligamentous damage
Reference
van Wettere and Redig (2004)
M
uller et al. (2007)
Bennett and Altman (1997)
Hatt (1999)
Roush (1980)
Rajchard and Rachac (2003)
Ackermann and Redig (1997)
Martin et al. (1993b)
Guzman Migallon-Sanchez et al.
(2007), Ward and Gartrell (2009)
M
uller et al. (2007)
Hatt (1999)
Holz (2003)
Martin and Ritchie (1994)
Bennett (1998)
Clipsham (1991a)
Harcourt-Brown (2000)
Fukui et al. (2005)
Bowles and Zantop (2002)
Naldo and Samour (2002)
Harcourt-Brown (2002)
Roush (1980)
Demirkan and Kilic (2003)
Zsivanovits (2011)
Harcourt-Brown (2002)
Elbow luxation
Veterinary Quarterly
ligaments (Ackermann & Redig 1997). The supporting
structures of the joint is a weak capsular membrane common to humerus, radius, and ulna two transverse radioulnar ligaments and the extensor and flexor muscles
(Ackermann & Redig 1997). Additionally, it contains a
cartilaginous meniscus (Roush 1980). Because of the
above-mentioned anatomy, the most common type of luxation is caudodorsal (75%) (Ackermann & Redig 1997)
followed by the caudal (37%) (Martin et al. 1993b). Ventral luxation occurs when a radial fracture is present (Bennett 1998). Special attention should be directed at open
wounds and soft-tissue injuries as they could affect the
release prognosis (Martin et al. 1993b). Elbow luxations
are common in wild birds, but infrequent to rare in companion birds (Bennett & Altman 1997; Hatt 1999). In various raptor species it represented a percentage of 2 and 12
of the caseload in two busy raptor centers (Martin et al.
1993b; Ackermann & Redig 1997). Moreover, in a report
of seven cases of elbow luxation in raptors, only three
returned to the wild (Souza et al. 2004). Additionally,
elbow luxations were reported in two white-tailed sea
eagles (M
uller et al. 2007). A permanent left elbow luxation has also been recorded in a rare Mauritian pink
pigeon (Columba mayeri) (Flach & Cooper 1991).
Another study reported 18 elbow luxations (with mostly
radius involved) in 239 wing fracture cases (Schuster &
Krautwald-Junghanns 1996).
3.2.4. Carpometacarpal joint luxation
An interesting case of carpal joint luxation was reported in
free-living, juvenile black-headed gulls (Larus ridibundus) (Rajchard & Rachac 2003). Many birds were presented with rotation of the metacarpal bones, but without
any fracture suspicion or active traumatic event. The luxation was attributed to the mudded soil compacting the
joints. Schuster has also reported few cases in wild and
pet birds (Schuster & Krautwald-Junghanns 1996) while
M
uller reported two cases of ulnocarpal luxation in whitetailed sea eagles (M
uller et al. 2007).
A condition which affects the carpometacarpal region
is the angel or slipped wing. It is commonly described in
waterfowl bred in captivity, although appearing in semiwild waterfowl too (Kreeger 1984; Olsen 1994), as well
as in psittacines, bustard chicks, and a Northern Goshawk
(Accipiter gentilis) (Zsivanovits et al. 2006). The birds are
presented with deformed primary feathers and rotation of
the metacarpal bones. The left wing is mainly affected
and the males are more susceptible (Olsen 1994). Nutrition (excessive energy and/or deficiency in vitamin E and
D), limited exercise, genetic factors, and management
practices have been implicated as etiologies of this condition (Olsen 1994).
3.2.5.
3.2.9.
Arthrodesis
Functional clinical outcome. Partial loss of ROM. Intra-articular histological changes.
Functional outcome. Good prognosis in recent luxations.
Intertarsal
Metatarsophalangeal
Note: ESF external skeletal fixator; HLTEF hinged linear transarticular external fixator; ROM range of motion; IM intramedullary.
Good
Normal grip and perch in a Cockatoo 10 weeks post-operation Gait and swim in 2
goslings 6 weeks post-operation with deficits
Possible re-luxation
Possible kidney injury
Salvage technique. Some return to normal ROM (pseudarthrosis)
Poor. Euthanasia.
Successful
Good
90% normal function after 14 months (Jaffe et al), weight bearing 14 days after
surgery (Fukui et al), functional outcome (Villaverde et al), near-normal range and
normal use 35 days post-operation (Chinnadurai et al)
Splint, sling
Transfixation (IM) pin
Excision arthroplasty with femoral head
osteotomy
Femoral head stabilization with
polypropylene sutures
None
Full leg splint
Intramedullary pins conjoined externally
Type II ESF
Bone plate
Treatment method
Femorotibial
Coxofemoral
Spine
Coracoid
Palatine bone
Scapulohumeral
Proximal coracoid
Elbow
Metacarpophalangeal
Carpal
Articulation
Table 2. Overview of the therapy and prognosis of each luxation as referred in the literature.
Doty (1979)
Martin et al. (1993a)
Martin et al. (1993a)
Ackermann and Redig (1997)
Reference
Veterinary Quarterly
7
3.3.2.
Many authors have reviewed the advantages and disadvantages of each method in fracture repair (Roush 1980;
Bennett & Kuzma 1992; Martin & Ritchie 1994; Bennett
1998; Harcourt-Brown 2002) but only few commented on
their use in luxation management (Roush 1980; Martin &
Ritchie 1994; Bennett 1998).
Intramedullary (IM) pinning: The transfixation of
shoulder and coxofemoral luxations with a smooth
unthreaded Steinmann pin has been proposed (Roush
1980). The pin is inserted through the trochanter into the
head of femur and across the acetabulum. The use of intramedullary pins has been described as well for stifle luxation (Zantop 2000; Bowles & Zantop 2002). A
craniolateral and a medial luxation in two monk parakeets
(Myiopsitta monachus) and an umbrella cockatoo (Cacatua alba) was reduced by inserting two IM pins normograde (Zantop 2000; Bowles & Zantop 2002). A 0.045-inch
diameter Kirschner wire was normograded into the tibiotarsal bone medially to the patellar ligament while a similar second wire entered the femoral cavity from the
greater trochanter. The exposed portion of each pin was
cut 2 cm from the joint, in a way that the end of each pin
was bent 90 cranial to its insertion. Afterwards, acrylic,
formed in a ball, was placed over the pins to provide stability. This technique was followed in experimental stifle
luxation in pigeons to compare it with other stifle fixation
techniques (Villaverde et al. 2005). A craniolateral luxation of the femur was fixed similarly, with the modification of conjoined edges of the intramedullary pins bended
in 90 towards each other (Harris et al. 2007). Finally,
two cases of palatine bone luxation have been treated
with a transverse intramedullary pin crossing the infraorbital sinus to displace the palatine bones ventrally. Then
the IM pin was removed and the reduced palatines were
bilaterally stabilized around the suborbital arch and jugal
bones with 3-0 polydioxanone absorbable sutures
(Foerster et al. 2000).
Extra-capsular stabilization technique: cortical screws
and tension bands have also been used to correct a luxated
joint in the avian patient. Jaffe et al. (2000) fixed a
1.5 mm and 16 mm long cortical bone screw to the lateral
femoral condyle of a macaw in order to reduce a medial
patellar luxation. A single strand of 0-nylon suture was
threaded to the proximal cnemial crest and anchored to
the screw head with the stifle aligned in a normal position.
Villaverde et al. (2005)) used a similar technique in their
experiments. Stifle-luxated pigeons were treated with a
cortical screw and a 3-0 nylon band through the fibular
crest while a second group was treated with an extra nylon
suture to the space between fibula and tibiotarsus ventral
to the fibular head. Another stifle reduction technique
using solely a 20-gauge cerclage wire was tested (Holz
1992). The wire was passed lateromedially, through predrilled holes in distal femur and proximal tibiotarsus, and
knotted laterally to act as collateral band, preventing the
mediolateral movement of the stifle. To further tighten the
fixation, the muscles were sutured with 4-0 Dexon. Additionally, a Thomas splint was applied for 15 days. In
Veterinary Quarterly
References
Ackermann J, Porter S. 1995. Femoral head osteotomy in a redshouldered hawk (Buteo lineatus). J Avian Med Surg.
9:127130.
Ackermann J, Redig PT. 1997. Surgical repair of elbow luxation
in raptors. J Avian Med Surg. 11:247254.
10
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luxation. In: Association of Avian Veterinarians, editor.
Conference of the Association of Avian Veterinarians; Aug
26; Portland (OR); p. 101104.
Kraus HK, Toombs PJ, Ness GM. 2003. External fixation in
small animal practice. Oxford: Blackwell Science.
Kreeger TWM. 1984. Carpometacarpal deformity in a giant Canada goose (Branta canadensis maxima Delacour). J Wildl
Dis. 20:245248.
MacCoy DM. 1989. Excision arthroplasty for management of
coxofemoral luxation in pet birds. J Am Vet Med Assoc.
194:9597.
Martin D, Ringdahl C, Scherpelz J. 1993a. Physical therapy for
specific injuries in raptors. In: Redig PT, Cooper JE, Remple
JD, Hunter DB, editors. Raptor biomedicine. Minneapolis
(MI): University of Minnesota Press; p. 207210.
Martin D, Ritchie W. 1994. Orthopedic surgical techniques. In:
Ritchie WR, Harrison JG, editors. Avian Med Princ Appl.
1st ed. Lake Worth (FL): Wingers Publishing; p. 11391169.
Martin H, Bruecker K, Herrick D, Scherpelz J. 1993b. Elbow
luxation in raptors: a review of eight cases. In: Redig PT,
Cooper JE, Remple JD, Hunter DB, editors. Raptor biomedicine. Minneapolis (MI): University of Minnesota Press;
p. 199206.
Martin HD, Kabler R, Sealing L. 1994. The avian coxofemoral
joint: a review of regional anatomy and report of an openreduction technique for repair of a coxofemoral luxation. J
Assoc Avian Vet. 8:164172.
Moisuk-Burgdorf A, Whittington JK, Bennett RA, McFaden M,
Mitchell M, OBrien R. 2011. Successful management of
simple fractures of the femoral neck with femoral head and
neck excision arthroplasty in two free-living avian species.
J Avian Med Surg. 25:210215.
M
uller K, Altenkamp R, Brunnberg L. 2007. Morbidity of freeranging white-tailed sea eagles (Haliaeetus albicilla) in Germany. J Avian Med Surg. 21:265274.
Naldo LJ, Samour HJ. 2002. Selected orthopedic cases in falcons
in Saudi Arabia. Exot DVM. 4:1113.
Naldo LJ, Samour HJ. 2004. Radiographic findings in captive
falcons in Saudi Arabia. J Avian Med Surg. 18:242256.
Olsen G. 1994. Anseriformes. In: Ritchie W, Harrison G, Harrison L, editors. Avian medicine: principles and applications.
1st ed. Lake Worth (FL): Wingers Publishing; p. 12371275.
Olsen GH, Redig PT, Orosz SE. 2000. Limb dysfunction. In:
Olsen GH, Orosz SE, editors. Manual of avian medicine. 1st
ed. St. Louis (MO): Mosby; p. 524.
Rajchard J, Rachac V. 2003. Defective wing development in
black-headed gull (Larus ridibundus) case report. Vet Med
(Praha). 48:373374.
Risi E, Ordonneau D, Gauthier O. 2005. Two cases of femoral head luxations in cormorants (Phalacrocorax carbo)
treated with a modified Meij-Hazewinkel-Nap technique.
In: Bailey T, Chitty J, Harcourt-Brown HN, Samour JH,
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