Toggle Pin Repair of Coxofemoral Luxation
There are a number of currently popular surgical methods for maintaining reduction of coxofemoral luxations that include: the toggle pin method, ilio-femoral sutures to limit external rotation of the hip, and caudo-distal transposition of the greater trochanter. Each of these methods depends on the joint capsule and associated muscles for acute, and especially for long-term maintenance, of joint stability. If the joint capsule is severely traumatized and not conducive to primary repair, some surgeons elect to perform a capsulorrhaphy or dorsal suture augmentation of the joint capsule. With any of the just mentioned surgical methods for stabilization of hip luxations, it is important to remember that the use of sutures and anchors must be considered temporary solutions until the joint capsule and periarticular soft tissue can heal. As such, patients with poor hip conformation are not good candidates for these methods of repair and should be considered for salvage procedures, such as FHNE or THR.
The toggle pin method of maintenance of coxofemoral luxations has been around many years. Commercially available toggle pins, Polypropylene Suture Buttons, and the Universal Aiming Device have simplified the method and increased its popularity. This method places a strand (or multiple strands) of suture material in a location that mimics the normal origin and insertion of the round ligament of the femoral head, which is torn when the hip is traumatically luxated. This anatomic positioning of suture material is relatively straightforward and visually demarcated in the hip, and perhaps is partially responsible for the logic and popularity of the method. Different suture materials and sizes are used based on the surgeon’s preference. IMEX™ customers use both monofilament and braided suture materials. Braided material is popular with customers who desire strength and knot security and tends to bend acutely around anchors or toggles better than monofilament suture material. Typical sizes include #2 and #5. Prolene®, Ethilon® and monofilaments are popular with customers who desire a relatively inert material, and common examples include monofilament fishing leader in 40 lb., 60 lb., and 80 lb. tests.
Three diameters are available for repair of coxofemoral luxations. The cross-hole sizes are compatible with most commonly used sizes of monofilament suture material.
Two-hole titanium suture buttons, like polypropylene suture buttons, are used at the lateral femur to simplify suture tie-off with the toggle pin method of hip luxation repair; additional uses include shoulder luxations and cruciate ligament repair. The paired 1.7mm holes will accommodate virtually all suture material choices.
These two-hole suture buttons are used at the lateral femur to simplify suture tie-off when performing the toggle pin method of coxofemoral reduction.
Similar to a large sewing needle with an eye, this suture passer is designed to be a very economical method of pulling suture down the femoral neck. The passer diameter is 3.2mm.
A high quality, adjustable aiming device for pre-drilling and pin placement. While commonly used for coxofemoral luxation repair with the toggle pin method, this instrument can also be used for many other applications.
Screw-in-place drill guides can be easily interchanged, and seven drill guide diameters are available. All drill guides can be purchased independently as needed.