hip toggles break off style

Placing a hip toggle has been a popular technique for managing hip luxations for many years. Despite being very intuitive in that it attempts to replace what was broken, the technique was not without problems. Placing the toggle was difficult in that the insertion point through the fovea of the acetabulum was both deep and dark, additionally the toggle itself, even the largest versions were small and difficult to hold and insert. Another major issue was that the inside of the hip joint is a very hostile environment for the toggle retaining suture which was subject to both tension and abrasion. Early failures were common. The break-off hip toggle combined with LigaFiba addresses these problems. The toggle is supplied as a 150mm pin with a break off point just above the toggle. Positioned into the inserter, the distal half of the toggle may be pushed into the hole in the acetabulum. Rocking the pin against the inserter breaks off the toggle which is then pushed through the hole using the broken off pin as a ‘pusher’. LigaFiba® is very strong (2.5 x as strong as monofilament nylon) with good abrasion resistance. It is easy to handle and requires a smaller acetabular hole for any given diameter of nylon. Despite being braided we have had very few reports of infection. Surgical Technique for Break Off Toggle. Most chronic hip luxations are in the cranio-dorsal position. The initial dissection is to expose the head of the femur prior to creating the bone tunnel and to expose the acetabulum. It is important to clear the acetabulum of soft tissue prior to the toggling procedure. Preserve the joint capsule as far as is possible. Key points to this procedure are: • Careful dissection and clearing of acetabulum • Accurate positioning of the femoral bone tunnel • Accurate positioning of the acetabular hole • Careful reduction and tensioning of the suture. • Over tensioning is as great a technical error as under tensioning. • Check for a full range of motion before final tying. Drill a bone tunnel from the fovea to the lateral femur. Use of a drill guide will help direct the the drill. Use 2.5mm drill. Drill a hole through the acetabular fossa large enough to allow the toggle and LigaFiba® to pass. 4.0mm drill for 3.0 toggle, 3.2mm drill for 2.5mm toggle. Load the break off toggle into the applicator from the distal end. Pull the LigaFiba® back along the shaft of the applicator to retain the toggle. Place the tip of the toggle through the hole in the acetabular fossa. Pressing the applicator into position will retain the LigaFiba®. Rock the shaft of the toggle pin to and fro until the shaft breaks off. Using the shaft, push the toggle through the hole in the acetabular fossa and ensure that it flips and engages. Pass a suture puller or folded fine wire from lateral femur through the bone tunnel and pull the LigaFiba® strands through. The strands are pulled tight but tied loosley over the button. Check for full range of motion and complete tie. Do not over tighten which will lead to early failure.