ULTRASONOGRAPHIC DIAGNOSIS OF COXOFEMORAL SUBLUXATION

IN HORSES

SUZANNE BRENNER, MARY BETH WHITCOMB

The clinical and ultrasonographic features of seven horses with coxofemoral subluxation are presented. Affected
horses included five adult geldings (11–20 years), one large pony (6 years) and a 3-month-old filly. All were lame
at the walk except for the pony with grade 3/5 lameness. Lameness was acute in all horses, but three horses
progressed after initial improvement. Crepitus, muscle atrophy, and pelvic asymmetry were inconsistent find-
ings. Ultrasonographic diagnosis of subluxation required dynamic visualization of femoral head displacement
from the acetabulum while placing weight on the affected limb and subsequent replacement into its normal
position upon limb resting. Acetabular rim fractures and joint effusion were visible regardless of weight bearing
status in six horses each. No fractures were identified in the pony; the only patient with a good outcome. Six
horses had a poor outcome with severe chronic lameness, four of which were euthanized. Postmortem vent-
rodorsal radiographs obtained in two horses confirmed subluxation only on extended limb projections, but not
on hip-flexed projections. Acetabular rim fractures were not visible radiographically in either horse but were
confirmed at necropsy. Subluxation was due to an elongated but intact ligament of the head of the femur in both
horses. Osteoarthrosis was evident ultrasonographically, radiographically, and at necropsy. Dynamic ultra-
sonography was readily performed in the standing horse and produced diagnostic images with a low frequency
curvilinear transducer. The apparent poor prognosis for horses with subluxation and acetabular fracture il-
lustrate the importance of this imaging technique to identify affected horses. Veterinary Radiology &
Ultrasound, Vol. 50, No. 4, 2009, pp 423–428.

Key words: acetabular fracture, dislocation, equine, hip, lameness, pelvis.

Introduction held in place by the transverse acetabular ligament. These

E QUINE HIND LIMB lameness of coxofemoral origin is
uncommon1–3 but does occur due to various disor-
ders.4 Equine coxofemoral subluxation is rare. To the au-
thors’ knowledge, only four such occurrences have been
reported; all diagnosed with ventrodorsal radiographic
projections.5–8 In an American Miniature horse with ra-
diographic evidence of subluxation, tearing of the ligament
of the head of the femur was found during coxofemoral
arthroscropy.7 In contrast, coxofemoral luxation has been
more commonly reported.9–17 Although a few ponies and
miniature horses with coxofemoral luxation have been
treated successfully,12,14–16 prognosis is generally poor with
persistent severe lameness.9,13,14
The low incidence of equine coxofemoral joint disease has
been attributed to its anatomic nature.10,12,14,15,17 The femoral
head is anchored deep in the acetabulum by the ligament of
the head of the femur and its accessory ligament, which are
From the Veterinary Medical Teaching Hospital (Brenner) and Depart-
ment of Surgical and Radiological Sciences (Whitcomb), School of Vet-
erinary Medicine, University of California, Davis, CA 95616.
Suzanne Brenner’s current address is Pioneer Equine Hospital, Inc.,
11501 Pioneer Avenue, Oakdale, CA 95361.
Address correspondence and reprint requests to Mary Beth Whitcomb,
at the above address. E-mail: mbwhitcomb@ucdavis.edu
Received August 25, 2008; accepted for publication December 21, 2008.
doi: 10.1111/j.1740-8261.2009.01560.x
structures, in combination with the fibrocartilagenous ace-
tabular lip, joint capsule and overlying musculature, allow the
coxofemoral joint to withstand significant forces.10,12,14,15,17
Although resistant to injury, falling or limb entrapment can
cause injury to one or more joint structures. The resultant
joint destabilization can ultimately lead to luxation or sub-
luxation. Such traumatic incidents are a common historical
feature of coxofemoral luxation.4,9,10,13,14
Accurate diagnosis of equine coxofemoral injury can be
challenging. Crepitus, pelvic asymmetry, or abnormal rec-
tal palpation are often absent.2,3,18 Once an injury is lo-
calized to the pelvic region, radiography and/or nuclear
scintigraphy19 may provide a diagnosis. Ventrodorsal ra-
diographs with the horse in dorsal recumbency are believed
to be most diagnostic1,2 but require general anesthesia and
the horse can sustain further injury during recovery.3 Two
techniques have been described for pelvic radiography in
the standing horse,20,21 but are not possible in the ambu-
latory setting and may not be possible with some in-house
radiographic equipment. Other disadvantages of these
techniques include limited visibility of the pelvis, reduced
visibility in large or fat horses, long exposure times, and
increased radiation exposure to personnel.20,21 Ultrasono-
graphic evaluation of the pelvis and coxofemoral joint can
be performed in the ambulatory and hospital setting with a

423
424 BRENNER AND WHITCOMB
standard ultrasound machine equipped with a low fre-
quency (2.5–5 MHz) transducer.18,22,23 Ultrasound has
been used to diagnose equine pelvic fractures18,24–26 and
coxofemoral luxation in calves.27 Ultrasound avoids the
risks of general anesthesia and is relatively inexpensive. The
purpose of this report is to describe the clinical and ultra-
sonographic features of seven horses with coxofemoral
subluxation diagnosed with dynamic ultrasonography in
the standing horse.
Materials and Methods
Records of horses examined with ultrasound between
February 2003 through February 2008 were reviewed. Seven
horses with an ultrasonographic diagnosis of coxofemoral
subluxation were identified. These horses represented 4.9%
(7/143) of horses that underwent ultrasonographic evalua-
tion of the hemipelvis during the 5-year period. Data ob-
tained from the medical record included signalment,
pertinent medical history, presenting complaints, clinical
findings, and results of diagnostic imaging.
There were five adult horses (mean 15.8 years, range 11–20
years), one adult large pony (6 years) and one foal (3 mos).
These included two Quarter Horses and one Arabian, Rocky
Mountain horse, Friesian, Morgan/Quarter Horse, and a
Welsh pony cross. Apart from the pony used as a show
hunter and the foal, horses were used for pleasure purposes.
Two horses had sustained trauma, including a fall and en-
trapment in pipe fencing. Another horse fell while attempting
to jump out of a corral, but it was unclear if this was directly
related to the injury. Lameness was associated with the onset
of a stall kicking habit in another horse. Four horses were
examined within 14–60 days from onset of lameness, and
three horses at 300–550 days due to progression of the initial
lameness. In two of these three horses, owners reported ad-
equate clinical improvement to resume riding, following
which the lameness returned and progressed.
The left hind limb was affected in four horses and the
right in three horses. All horses were lame at the walk
(Grade 4/5—AAEP grading scale28) with the exception of
the pony that had a Grade 3/5 lameness. In three horses,
axial placement of the contralateral foot toward midline was
noted while standing and during the stance phase of the
stride (Fig. 1A). Audible or palpable crepitus was noted in
three horses and pelvic asymmetry in two horses. Unilateral
gluteal atrophy was present in four horses, all with lameness
present for 460 days. Two of these horses also had quad-
riceps atrophy (Fig. 1B). Such localizing findings were ab-
sent in two horses, although one horse had swelling over the
tuber coxae to suggest pelvic injury. Only one horse had all
three clinical signs. Rectal palpation was performed in four
horses and bony asymmetry was found in one horse.
All horses underwent an ultrasonographic examination of
the affected hemipelvis, including the ilial wing, ilial body,
2009
Fig. 1. (A) Axial placement of the right rear foot with associated varus
deformity of the tarsus in an 11-year-old Rocky Mountain horse with left
coxofemoral subluxation. (B) Atrophy of the left gluteal and quadriceps
musculature in the same horse.
coxofemoral joint, ischium, tuber sacrale, tuber coxae, and
tuber ischii. Ultrasonographic evaluation of the pelvis was
performed based on localizing signs in six horses and nu-
clear scintigraphic findings of intense radiopharmaceutical
uptake of the coxofemoral joint in the pony. Transrectal
sonography was performed where appropriate. Examina-
tions were performed and interpreted by ultrasonographers
with prior experience in pelvic ultrasonography.
The hair of the hemipelvis was clipped with a #50 blade,
the skin washed and ultrasound coupling gel applied before
each exam. A low frequency (2.5–5.0 MHz) curvilinear
transducer was used in all horses to evaluate the coxofem-
oral joint. Transverse views were obtained by following the
longitudinal surface of the ilial body to the cranial aspect of
the coxofemoral joint. The craniodorsal and dorsal surfaces
of the joint were next evaluated by sliding the transducer in
a dorsocaudal direction while simultaneously aiming ven-
trally to avoid interference with the greater trochanter of
the femur (Fig. 2). In all horses, dynamic ultrasonography
was performed to observe the position of the femoral head
relative to the acetabulum while weight bearing and non-
weight bearing (resting) on the affected limb.
Results
All horses had dorsal displacement of the femoral head
relative to the acetabulum during ultrasonographic weight
bearing views (Fig. 3; A video of the examination accom-
panies the online version of this manuscript). Horses often
preferred to stand with the abnormal limb in the resting
Vol. 50, No. 4 DIAGNOSTIC ULTRASOUND---COXOFEMORAL SUBLUXATION
Fig. 2. Reference ultrasonographic image of the normal coxofemoral
joint with corresponding anatomic specimen. Note the transducer orienta-
tion used to obtain a transverse view of the dorsal aspect of the joint. (A,
acetabulum; FH, femoral head; GT, greater trochanter; IB, ilial body; O,
obturator foramen; TI, tuber ischii; 3T, third trochanter of the femur.)
position, in which instance the femoral head was visible
within the acetabulum (Fig. 4A). Subluxation was not vis-
ible ultrasonographically until the horse either willingly
placed full weight on the limb or was encouraged to do so
by gentle tail pulling toward the affected side (Fig. 4B). The
abnormal position of the femoral head was most notable
when viewed from the craniodorsal aspect of the joint.
Subluxation vs. luxation was diagnosed based on return of
the femoral head to its normal position when the horse
resumed resting the limb. Acetabular rim fractures were
present in six of seven horses and were visible regardless of
weight bearing status (Fig. 5). No evidence of acetabular
rim fracture was detected in the pony despite a history of
falling. Effusion and synovitis of the coxofemoral joint
capsule was visible in six horses, most apparent within a
large recess cranial to the proximal aspect of the femur
(Fig. 6). Roughening of the femoral head and neck was
detected in four horses. In one horse, an acetabular rim
fracture was identified on the initial ultrasound examina-
tion, but subluxation was not detected because weight
bearing views were not obtained. This horse remained se-
verely lame despite daily administration of nonsteriodal
Fig. 3. Ultrasonographic image with corresponding anatomic specimen.
Note the dorsal displacement of the femoral head relative to the acetabulum
due to coxofemoral subluxation. (A, acetabulum; FH, femoral head; GT,
greater trochanter; IB, ilial body; O, obturator foramen; TI, tuber ischii; 3T,
third trochanter of the femur.)
425
Fig. 4. Nonweight bearing (A) and weight bearing (B) transverse ultra-
sonographic images of the craniodorsal aspect of the coxofemoral joint in a
3-month-old Friesian filly. The femoral head (FH) is located in a near nor-
mal position relative to the acetabulum during limb resting (A). A small
acetabular fragment (arrow) and femoral physis (arrowhead) are visible.
Upon weight bearing, the femoral head becomes markedly displaced relative
to the acetabulum (B). Images obtained with a 2.5–5 MHz curvilinear trans-
ducer set at 5.0 MHz; depth setting ¼ 12.9 cm.
anti-inflammatory medication. Subluxation was subse-
quently diagnosed on a recheck ultrasound examination
performed 4 months later when weight bearing views were
performed. Transrectal ultrasound was performed in four
horses; no additional fractures were detected, but severe
joint effusion and synovial thickening was visible through
the obturator foramen in one horse.
Four horses were euthanized for reasons related to the
injury. Three horses were euthanized shortly after diagno-
sis (1–3 days) and one was euthanized approximately 1
year later due to persistent lameness. Postmortem
radiographs were obtained in two horses and included
ventrodorsal projections with the hind limbs in the stan-
dard hip-flexed position and also with the hind limbs in
extension. Subluxation was not present in the hip-flexed
views (Fig. 7A) but was confirmed using the hip-extended
position (Fig. 7B). Acetabular rim fractures were not
radiographically apparent in either horse. Subluxation was
not apparent in a standing lateral pelvic radiograph ob-
Fig. 5. Nonweight bearing (A) and weight bearing (B) transverse ultra-
sonographic images of the craniodorsal aspect of the coxofemoral joint from
a 17-year-old Quarter Horse gelding. An acetabular fracture (arrows) is vis-
ible, irrespective of weight bearing status. The femoral head (FH) has an
irregular surface and is dorsally displaced on the weight bearing view (B).
Images obtained with a 2.5–5 MHz curvilinear transducer set at 4.0 MHz;
depth setting ¼ 14.6 cm.
426 BRENNER AND WHITCOMB
Fig. 6. Longitudinal ultrasonographic image of severe coxofemoral effu-
sion within the large cranioventral recess (arrows) at the level of the proximal
femur. The craniolateral aspect of the femoral head (FH) has a markedly
irregular surface in this horse with longstanding lameness. Image obtained
with a 2.5–5 MHz curvilinear transducer set at 4.0 MHz; depth set-
ting ¼ 16.3 cm.
tained before euthanasia in one of these horses. Grossly,
there was partial tearing and stretching of the ligament
of the head of the femur and the accessory ligament in
both horses. Acetabular fractures of the dorsal rim
and severe osteoarthritis involving the femoral head
and acetabulum were also found. Postmortem examina-
tion was not performed on the other horses undergoing
euthanasia.
Of the three surviving horses, two continue to have
prominent lameness at the walk. Utrasound-guided intra-
synovial injection of the coxofemoral joint with cortico-
steroids, hyaluronic acid, and amikacin resulted in an
increased comfort and activity level in one of these horses,
but distal extremity lameness in the contralateral hind limb
developed 90 days later. The other horse remains lame 2
years after diagnosis despite treatment with various alter-
native therapies. The pony was retired from showing but is
occasionally ridden at the walk with a mild (grade 1/5)
residual lameness 1.5 years post injury. Treatment of the
pony primarily consisted of weight reduction and small
paddock confinement.
Discussion
Accurate diagnosis of coxofemoral disorders is important
in horses with pelvic injury, especially in horses with ace-
tabular fracture where an additional finding of subluxation
may not be immediately apparent. Acetabular fractures
occur with some frequency in horses with pelvic injury, of-
2009
Fig. 7. Ventrodorsal radiographic projections obtained in dorsal recum-
bency after euthanasia from an 11-year-old Rocky Mountain horse with an
18 month history of LH lameness. In the hip-flexed projections (A) there is
osteoarthritis of the left coxofemoral joint (upper right), but no evidence of
subluxation. Extended limb projections (B) confirm subluxation of the left
coxofemoral joint (lower right). The joint space is widened, and the femoral
head is partially displaced from the acetabular rim.
ten due to a fall or other traumatic event.1–3,6,18 While some
horses are euthanized at the time of diagnosis, a surprisingly
large number of treated horses (23/31) with acetabular
fractures were reported to have a good outcome in one
study.3 In contrast, all six horses with a combination of
subluxation and acetabular rim fractures in the current
study had a poor outcome. Four were euthanized due to
longstanding severe lameness and two horses remain mark-
edly lame. Acetabular rim fractures may contribute to
postreduction instability in humans with traumatic frac-
ture–dislocations.29,30 The decision for surgical stabilization
is partially based on fracture size and configuration because
postreduction instability is associated with an inferior out-
come in people.29,30 Surgical treatment was not considered
for any horse in this study. Multiple techniques for cor-
recting a coxofemoral luxation have been described, but
none have been successful in adult horses.9,11–14,16 The only
patient in our study with a good outcome did not have a
visible acetabular fracture. This outcome is similar to that
in humans with simple coxofemoral dislocations, although
a direct comparison between species is difficult because joint
reduction in humans is typically successful.30 Additional
factors that may have contributed to the positive outcome
Vol. 50, No. 4 DIAGNOSTIC ULTRASOUND---COXOFEMORAL SUBLUXATION
in this patient include prompt diagnosis and the relatively
small size of the pony compared with full size adult
horses.
Five of seven horses were adults, ranging in age from 11
to 20 years. This is in contrast to coxofemoral luxation that
occurs more frequently in immature horses, miniature
horses, and ponies.10,14 Although our population con-
tained one pony, it was a relatively large pony. It is inter-
esting that physical findings were not suggestive of
coxofemoral subluxation in horses in this study. Upward
fixation of the patella and external rotation of the affected
limb are frequent findings in horses with coxofemoral
luxation9–12,14–16; however, such findings were
not observed in our horses. Five horses did have clinical
signs (crepitus, pelvic asymmetry, and gluteal atrophy)
suggestive of pelvic injury, but none were considered path-
ognomonic for coxofemoral injury and may be present
with other pelvic injury.2,3,18 Similar to other reports of
pelvic disorders, such localizing findings were inconsis-
tently seen, as only one horse had all three clinical
signs and two horses had none. An interesting clinical
finding was midline foot placement of the contralateral
hind limb in three horses. This was considered a compen-
satory mechanism for the severe lameness and resulted in a
slight to moderate tarsal varus deformity in all three
horses.
Ultrasound was instrumental in the diagnosis of coxo-
femoral subluxation in all horses, but required the use of
dynamic real-time imaging to evaluate joint movement.
Craniodorsal subluxation was noted in all horses and
mirrors that reported for luxation in horses and other
species.14,27,31 Six of seven horses had acetabular rim frac-
tures that were readily seen on ultrasound regardless of
weight bearing status. Because acetabular fracture can
explain the severity of lameness in acutely affected horses,
it was important to obtain weight bearing views to rule out
the additional diagnosis of subluxation. In fact, the first
coxofemoral subluxation was found inadvertently by ob-
servation of femoral head displacement from the ace-
tabulum during the transition from limb resting to full
weight bearing. Subsequent to this diagnosis, all horses are
made to bear weight on the affected limb by gentle tail
pulling or by applying pressure to the contralateral tuber
coxae.
Standing lateral oblique and ventrodorsal radiographs
were not performed in this study as our radiographic
equipment cannot be positioned to obtain these views.
Standing lateral oblique radiographs have been used to
diagnose coxofemoral luxation in other studies.8,21 Because
our patients were often reluctant to stand on the affected
limb, it is unlikely that subluxation would have been ev-
ident using these techniques unless horses were forced to
bear full weight during radiographic acquisition. This
would require additional personnel in the radiology suite
427
and increase radiation exposure. Coxofemoral subluxation
was only evident with ventrodorsal extended limb projec-
tions obtained in dorsal recumbency. These views were
readily obtained by holding the limbs extended with ropes
that were then tied to the radiology table. Superimposition
of the stifle joint and quadriceps musculature did not oc-
cur, as has been suggested.32 While these projections con-
firmed subluxation in the two horses in which they were
used, the risks of general anesthesia and further injury
during anesthetic recovery would have to be considered for
antemortem diagnostic purposes. The inability to visualize
dorsal acetabular rim fractures on ventrodorsal projections
in both horses was likely the result of summation and is
also reported in humans with fracture–dislocations.29 The
location and presence of these fractures were confirmed at
necropsy and was consistent with that seen ultrasono-
graphically.
Subluxation was due to partial tearing and stretching of
the round ligament and acetabular rim fractures in the two
horses undergoing postmortem examination (horses 2 and
5). Horse 2 had severe lameness that remained unchanged
despite 6 months of stall confinement. In contrast, horse 5
improved sufficiently to be ridden lightly, at which point
the lameness returned and progressed over 1.5 years. Nec-
ropsy findings in both horses were similar; however, their
clinical history, and that of other horses, suggests two
possible mechanisms of injury. In horses with acute and
severe persistent lameness, acetabular fracture and round
ligament injury most likely occurred simultaneously. In
horses with insidious lameness, round ligament injury, and
subluxation may have developed as a long-term conse-
quence of destabilization by acetabular rim fracture(s).
Other possibilities for the worsening condition in these
horses include osteonecrosis of the femoral head and/or
progressive osteoarthrosis. Osteonecrosis of the femoral
head can occur as a complication of traumatic hip dislo-
cation or subluxation in humans, especially if reduction is
delayed beyond 12 h.33,34 While histopathologic evaluation
of the femoral head was not performed in either horse,
radiographic and gross findings did not support this as a
cause of subluxation.
The identification of seven horses with coxofemoral
subluxation within a 5-year period at our hospital suggests
that it is more common than has been reported. Coxofem-
oral subluxation should be considered for any horse with
hind limb lameness suspected to originate from the pelvic
region. Diagnosis can be readily and safely obtained
through the use of dynamic ultrasound in the standing
horse provided that weight bearing and resting views are
performed. Similar to that reported for luxation, the com-
bination of subluxation, and acetabular fracture can cause
severe lameness and may result in a less favorable prog-
nosis compared with that reported for horses with acetab-
ular fracture as the sole coxofemoral abnormality.
428 BRENNER AND WHITCOMB
REFERENCES
1. Jeffcott LB. Pelvic lameness in the horse—a report on 110 cases.
Equine Pract 1982;4:21–47.
2. Little C, Hilbert B. Pelvic fractures in horses: 19 cases (1974–1984).
J Am Vet Med Assoc 1987;190:1203–1205.
3. Rutkowski JA, Richardson DW. A retrospective study of 100 pelvic
fractures in horses. Equine Vet J 1989;21:256–259.
4. Hendrickson DA. The coxofemoral joint. In: Stashak TS (ed):
Adams’ lameness in horses, 5th ed. Philadelphia: Lippincott Williams &
Wilkins, 2002;1037–1043.
5. Davidson PJ. A case of coxo-femoral subluxation in a Welsh pony.
Vet Rec 1967;80:441–444.
6. Heinze CD, Lewis RE. Radiographic examination of the equine pel-
vis: case reports. J Am Vet Med Assoc 1971;159:1328–1334.
7. Nixon AJ. Diagnostic and operative arthroscopy of the coxofemoral
joint in horses. Vet Surg 1994;23:377–385.
8. May SA, Harrison LJ. Radiography of the hip and pelvis. Equine Vet
Educ 1994;6:152–158.
9. Mackay-Smith MP. Management of fracture and luxation of the
femoral head in two ponies. J Am Vet Med Assoc 1964;145:248–251.
10. Bennett D, Campbell JR, Rawlinson JR. Coxofemoral luxation
complicated by upward fixation of the patella in the pony. Equine Vet J
1977;9:192–194.
11. Trotter GW, Auer JA, Arden W, et al. Coxofemoral luxation in two
foals wearing hindlimb casts. J Am Vet Med Assoc 1986;189:560–561.
12. Platt D, Wright IM, Houlton JEF. Treatment of chronic coxofem-
oral luxation in a Shetland pony by excision arthroplasty of the femoral
head: a case report. Br Vet J 1990;146:374–379.
13. Squire RE, Fessler JF, Toombs JP, et al. Femoral head ostectomy in
horses and cattle. Vet Surg 1991;20:453–458.
14. Malark JA, Nixon AJ, Haugland MA, et al. Equine coxofemoral
luxations: 17 cases (1975–1990). Cornell Vet 1992;82:79–90.
15. Clegg PD, Butson RJ. Treatment of a coxofemoral luxation sec-
ondary to upward fixation of the patella in a Shetland pony. Vet Rec 1996;
138:134–137.
16. Garcia-Lopez JM, Boudrieau RJ, Provost PJ. Surgical repair
of coxofemoral luxation in a horse. J Am Vet Med Assoc 2001;219:
1254–1258.
17. Portier K, Walsh CM. Coxofemoral luxation in a horse during re-
covery from general anaesthesia. Vet Rec 2006;159:84–85.
18. Almanza A, Whitcomb MB. Ultrasonographic diagnosis of pelvic
fractures in 28 horses.. Proc Am Assoc Equine Pract 2003;49:50–54.
19. Davenport-Goodall CLM, Ross MW. Scintigraphic abnormal-
ities of the pelvic region in horses examined because of lameness or
poor performance: 128 cases (1993–2000). J Am Vet Med Assoc 2004;224:
88–95.
20. May SA, Patterson LJ, Peacock PJ, et al. Radiographic technique
for the pelvis in the standing horse. Equine Vet J 1991;23:312–314.
21. Barrett EL, Talbot AM, Driver AJ, et al. A technique for pelvic
radiography in the standing horse. Equine Vet J 2006;38:266–270.
22. Tomlinson JE, Sage AM, Turner TA. Detailed ultrasonographic
mapping of the pelvis in clinically normal horses and ponies. Am J Vet Res
2001;62:1768–1775.
23. Goodrich LR, Werpy NM, Armentrout A. How to ultrasound the
normal pelvis for aiding diagnosis of pelvic fractures using rectal and trans-
2009
cutaneous ultrasound examination. Proc Am Assoc Equine Pract
2006;52:609–612.
24. Shepherd MC, Pilsworth RC. The use of ultrasound in the diagnosis
of pelvic fractures. Equine Vet Edu 1994;6:223–227.
25. Pilsworth RC, Shepherd MC, Herinckx BMB, et al. Fracture of the
wing of the ilium, adjacent to the sacroiliac joint, in Thoroughbred race-
horses. Equine Vet J 1994;26:94–99.
26. Tomlinson J, Sage A, Turner TA. Ultrasonographic examination of
the normal and diseased equine pelvis. In Proceedings. Am Assoc Equine
Pract 2000;46:375–377.
27. Starke A, Herzog K, Sohrt J, et al. Diagnostic procedures and sur-
gical treatment of craniodorsal coxofemoral luxation in calves. Vet Surg
2007;36:99–106.
28. American Association of Equine Practitioners. American Associa-
tion of Equine Practitioners Lameness Grading Scale. Available at: http://
www.aaep.org/health_articles_view.php?id ¼ 280 accessed on August 25,
2008.
29. Brooks RA, Ribbans WJ. Diagnosis and imaging studies of trau-
matic hip dislocations in the adult. Clin Orthop Relat Res 2000;377:15–23.
30. Sahin V, Karakas ES, Aksu S, et al. Traumatic dislocation and
fracture-dislocation of the hip: a long-term follow-up study. J Trauma
2003;54:520–529.
31. Basher AWP, Walter MC, Newton CD. Coxofemoral luxation in the
dog and cat. Vet Surg 1986;15:356–362.
32. Lewis RE, Heinze CD. Radiographic examination of the equine
pelvis: technique. J Am Vet Med Assoc 1971;159:1387–1390.
33. Rodriguez-Merchan EC. Osteonecrosis of the femoral head after
traumatic hip dislocation in the adult. Clin Orthop Relat Res 2000;377:
68–77.
34. Moorman CT, Warren RF, Hershman EB, et al. Traumatic poste-
rior hip subluxation in American football. J Bone Joint Surg Am 2003;
85A:1190–1196.
Supporting Information
Additional supporting information may be found in the
online version of this article:
Video S1. (Dynamic Joint Movement): Ultrasono-
graphic video. Note the subluxation of the left coxofemoral
joint in a 3-month-old Friesian filly. The femoral head (on
left) becomes displaced in a craniodorsal direction from the
acetabulum (on right) during weight bearing and then
returns to the acetabulum during limb resting. Joint
effusion and a small acetabular fracture are also visible.
Please note: Wiley-Blackwell is not responsible for the
content or functionality of any supporting materials
supplied by the authors. Any queries (other than missing
material) should be directed to the corresponding author
for the article.