Management of fractures and orthopaedic disease

image of Management of fractures and orthopaedic disease
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This chapter will focus on brief discussion of the important fractures and orthopaedic diseases that are encountered in feline practice, notably pelvic and sacroiliac fractures/luxation, skull fractures including mandibular symphyseal separation, hip luxation and dysplasia, femoral fractures, cruciate rupture, patellar luxation and fractures, stifle derangement, tibial, humeral and radial fractures, carpal and metacarpal injuries and degenerative joint disease (DJD).

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16.1 Using a ventrodorsal radiograph of the cat’s pelvis, the intersacral distance (arrowed and labelled S) can be compared to the interacetabular distance (arrowed and labelled A). The S:A ratio in this radiograph of a normal cat is 1:0.97 (in practical terms this can be considered to be 1:1).
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16.2 This cat sustained a pelvic fracture in an RTA and has mild proprioceptive deficits in the left pelvic limb. The fracture fragments were minimally displaced and the injury was treated conservatively: strict cage rest for 3 weeks followed by supervised limited exercise (no jumping) outside the cage for a further 3 weeks, before allowing unsupervised activity and a return to being allowed outside. There was a complete recovery from the neurological deficits within 2 weeks.
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16.3 Cerclage wiring of a mandibular symphyseal separation. (Adapted from Montavon . ( ), with permission.)
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16.4 This cat sustained a fracture of the mandibular body following an RTA, which resulted in dental malocclusion. Surgical reduction and stabilization are required to restore good function. These fractures can be challenging to repair, and referral to a specialist should be considered.
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16.6 Ventrodorsal radiograph showing a temporary 1.6 mm transarticular pin, which was placed after a left hip dislocation. This technique can be used with good success for dislocated hips in cats and is the author’s preferred method as it has a good success rate in maintaining reduction of the hip even if other techniques have failed. Pin placement must be central in the femoral head and the pin must be large enough to be stiff so that it will not break. The pin does need removal, necessitating a second period of anaesthesia, after 2–4 weeks. In simple cases, where the only injury is a hip luxation, the pin can usually be removed after 2 weeks; in more complicated cases, where there are additional injuries, other legs affected or neurological deficits, then it is recommended that the pin is left for 4 weeks.
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16.7 A traumatic femoral capital physeal fracture is shown on this craniocaudal view of the femur; the fracture occurs through the capital physis. This occurred after an RTA in which the 8-month-old cat also sustained a distal femoral fracture and a comminuted tibial fracture on the same leg. Craniocaudal radiograph of the femur showing stabilization of the femoral capital physeal fracture with three small stainless steel arthrodesis wires (0.9 mm diameter).
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16.8 This 18-month-old neutered male cat presented with bilateral pelvic limb lameness and hip pain over a duration of 4 weeks. The ventrodorsal radiograph shows bilateral capital physeal fractures, with resorption (seen as lucency) and narrowing of the femoral necks. These changes are consistent with slipped capital femoral epiphyses (atraumatic fractures).
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16.9 This 14-year-old hyperthyroid cat sustained a femoral diaphyseal fracture of unknown cause. Craniocaudal and mediolateral radiographs show the interlocking nail repair of the proximal third femoral fracture, using a 4.0 mm nail. This repair method was chosen as it was anticipated that the fracture would take a long time to heal in this elderly cat with osteopenia (seen as a double cortical line). The interlocking nail implant is placed inside the bone and is therefore very resistant to bending forces; and the interlocking nature of the bolts prevents rotation and shear of the fracture fragments. Plate and screw fixation could have been used but there was limited space in the proximal fragment for placement of many screws (ideally requires a minimum of three). External skeletal fixation was not considered optimal in this cat as it has osteopenia and it was therefore anticipated that pin-holding might be poor in the bone, which could result in premature pin loosening. This would not be good in a cat where fracture healing was anticipated to be slow.
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16.10 A 5-month-old male cat presented after unknown trauma with severe lameness of the right hindlimb. Mediolateral radiograph showing a distal femoral condylar fracture with proximocaudal displacement of the femoral condyle. Craniocaudal and mediolateral radiographs after the fracture had been reduced and stabilized with two small arthrodesis wires placed as cross pins.
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16.11 Craniocaudal radiograph showing a medial patellar luxation in a 9-year-old male cat. There is also synovial osteochondromatosis, with joint mice that have migrated into the extension of the joint capsule around the long digital extensor tendon; this condition can be seen in osteoarthritic joints. A wedge recession sulcoplasty had been performed for a previous luxation of the same patella when the cat was 1 year old. He had not then shown any lameness until there was an acute deterioration with marked lameness 2 days prior to referral. The patella was permanently luxated; although it was possible to reduce it into the groove, it reluxated almost immediately on release (grade III). Revision surgery was performed on the cat and the groove was found not to be wide enough for the patella to sit in, so it was deepened by performing a block recession sulcoplasty. The cat recovered well after surgery and it was walking well at a 4-week postoperative check.
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16.12 Mediolateral radiograph of a transverse tibial stress fracture and a proximal fibular fracture in a 10-year-old female cat with a chronic patellar non-union fracture. There is sclerosis of the tibia around the fracture and thickening of the cranial tibial cortex, which is characteristic of these fractures. The patella has enthesophytosis (bone or mineral deposition at the sites of soft tissue, such as ligaments, inserting on to bone) affecting the proximal and distal aspects, and there is pronounced metaplastic bone formation, which is a characteristic of some chronic patellar fractures in cats. This cat also had a history of atraumatic humeral condylar fractures and a contralateral tibial and patellar fracture, all at different times in the past.
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16.13 Craniocaudal tarsal radiograph showing a distal tibial epiphyseal fracture in an 8-month-old male cat, stabilized with two cross pins. The repair is usually protected by external coaptation or a TESF for 4 weeks postoperatively.
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16.14 Mediolateral and craniocaudal views of the elbow and proximal antebrachium of a 5-year-old cat that had suffered a fall. There is a mildly comminuted fracture of the proximal ulna and cranial luxation of the radial head, with significant soft tissue swelling. This injury is known as a Monteggia lesion. It is important that both the ulnar fracture and the radial head luxation are repaired, and that the annular ligament that holds the radius and ulna in close contact is replaced with a prosthetic ligament or suitable alternative such as a screw placed between the radius and ulna.
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16.15 Mediolateral radiograph of an 8-year-old cat presented with a simple distal ulnar fracture and a comminuted radial fracture; the type of trauma that caused the injury was unknown. The fracture healed after reduction and stabilization (intramedullary pin in the ulna, placed in a retrograde fashion from the ulnar fracture site; a 2.0 mm dynamic compression plate applied craniomedially to the radius) and a cancellous bone graft.
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