Cage rest or fix? Cat pelvis

Re: Cage rest or fix? Cat pelvis

Malcolm Ness — Fri, 10 Feb 2012 09:57:36 GMT

[quote user="David Beattie"]

Articular Fractures: Does an Anatomic Reduction Really Change the Result? (2002) Marsh, Buckwalter, Gelberman, Dirschl, Olson, Brown, Llinias

The Journal of Bone & Joint Surgery. 2002; 84:1259-1271

[/quote]

There is a lot of stuff like this written and it is on the basis of this kind of work that I caution against rushing in to operate. The problem comes from the fact that whilst anatomic reduction and rigid fixation is necessary to promote primary bone union and restoration of a smooth bearing surface, it is only very rarely achieved (despite the aspirations of the surgeon). Implants are a significant factor - dynamic compression plates produce compression and therefore stability but they do so by moving the fragments relative to one another which is exactly what you don't want having just anatomically reduced the fracture. Similarly, lag screws, while effective in the short term are not terribly strong compared with the forces they are placed to resist and the consequence is that it is often difficult or impossible to achieve the ideal. That is not to say that most cases don't do well, they do because an acceptable degree of function can be expected without perfect restoration of anatomy as I suspect this cat case will show.

Re: Cage rest or fix? Cat pelvis

Hannah Wynne Richards — Fri, 10 Feb 2012 09:18:14 GMT

Again not an orthopod, but again voice of experience

I would :a) cage rest for 6 weeks on metacam

b) if unsuccessful refer if at all possible-Malcolm will probably curse me for making surgery more difficult by waiting-but he doesn't see the very many who do well on cage rest

c) excision of femoral head as last resort

Wynne

Re: Cage rest or fix? Cat pelvis

Anonymous — Fri, 10 Feb 2012 09:07:54 GMT

[quote user="Malcolm Ness"]This is an articular fracture so successful surgical treatment requires perfect (not just very good but absolutely perfect) reduction[/quote]

Is this relating specifically to acetabular fractures in cats or is this generally considered an accepted mantra for any articular fracture?

I'm sure there's been a lot published since I read:

Articular Fractures: Does an Anatomic Reduction Really Change the Result? (2002) Marsh, Buckwalter, Gelberman, Dirschl, Olson, Brown, Llinias

The Journal of Bone & Joint Surgery. 2002; 84:1259-1271

but I didn't find the weight of evidence particulary convincing at the time for the general mantra.

Re: Cage rest or fix? Cat pelvis

Lorna McHardy — Thu, 09 Feb 2012 19:36:22 GMT

[quote user="Malcolm Ness"]

Sadly not true and irrelevant anyway. I don't know where that old chestnut about bones in the same room came from originally

[/quote]

I forgot the smiley!

[quote user="Malcolm Ness"]

I would house rest this cat for a couple of weeks on metacam (or similar) and then maintain it on NSAIDs for at least six weeks.

[/quote]

Not even cage rest? I'm never quite sure when house rest is sufficient, and therefore almost certainly cage rest quite a few that don't necessarily need it.

Re: Cage rest or fix? Cat pelvis

Neil Wheadon — Thu, 09 Feb 2012 17:53:38 GMT

Cracking reply (no pun intended) and precisely what we're doing, but wasn't 100% sure hence the question.

Mother Francis (had kittens 3 weeks ago) is weight bearing and very happy, just wasn't too sure of her long term mobility.

Martins answer contains the 'I'm not an orthopod' but experience counts for a lot, so thankyou

Neil

Re: Cage rest or fix? Cat pelvis

Malcolm Ness — Thu, 09 Feb 2012 17:46:51 GMT

[quote user="Lorna McHardy"]Put a cat and its bones in the same room and they'll heal...[/quote]

Sadly not true and irrelevant anyway. I don't know where that old chestnut about bones in the same room came from originally but it has been the cause/justification of far too many feline orthopaedic abuses. The aim of fracture management is the restoration of function. A great many bones will heal leaving the patient significantly disabled, other times conservative management is the preferred treatment option in cats, dogs, humans and probably other species.

Martin is, in large part, correct in his remarks about pelvic fracture surgery - it is technically demanding and associated with a significant risk of failure and/or iatrogenic injury.

This is an articular fracture so successful surgical treatment requires perfect (not just very good but absolutely perfect) reduction and rigid (not just stiff but rigid) fixation. That is extremely difficult to achieve given the limitations on implant size and anatomy. If you don't achieve both of the above then you might as well have managed the case conservatively and the good news is that this cat will almost certainly do very well with conservatism. The major load bearing region of the acetabulum is the cranio-dorsal quadrant and since this appears intact in this case and there is no obvious evidence of the other fragments impinging the joint, the outlook for restoration of near normal function is very good. I would house rest this cat for a couple of weeks on metacam (or similar) and then maintain it on NSAIDs for at least six weeks.

Re: Cage rest or fix? Cat pelvis

Malcolm Ness — Thu, 09 Feb 2012 17:46:19 GMT

[quote user="Lorna McHardy"]Put a cat and its bones in the same room and they'll heal...[/quote]

Martin is, in large part, correct in his remarks about pelvic fracture surgery - it is technically demanding and associated with a significant risk of failure and/or iatrogenic injury.

Re: Cage rest or fix? Cat pelvis

Simon Neuhoff — Thu, 09 Feb 2012 17:42:35 GMT

Ideally - funds permitting - fix it.

Re: Cage rest or fix? Cat pelvis

Martin Atkinson — Thu, 09 Feb 2012 17:25:50 GMT

No fractures lend themselves less to orthopaedic surgery that pelvic fractures. I the cat is able to stand and there is no compression of the pelvic canal if it was my cat I'd give it cage rest. I would doubt that there would be a need for an excision arthroplasty, the head of the femur is not damaged. But then I'm not an orthopaedic surgeon.

Re: Cage rest or fix? Cat pelvis

Clive Ansell — Thu, 09 Feb 2012 17:25:05 GMT

1) cage rest, initially at least.

I have a very similar case on the go at the moment, with almost identical radiographs. About a month ago now. cat had difficulty passing urine and faeces for the first 5-7 days, but has been fine since and has been increasingly weight bearing, doing incredibly well just on Metacam.

Re: Cage rest or fix? Cat pelvis

Lorna McHardy — Thu, 09 Feb 2012 17:24:11 GMT

Put a cat and its bones in the same room and they'll heal...

this doesn't look particularly displaced despite the several bits, so I'd cage rest it.

Re: Cage rest or fix? Cat pelvis

Louise6732 — Thu, 09 Feb 2012 17:23:46 GMT

I think this one needs surgery as it has an acetbaular fracture which is a weight bearing axis in the pelvis.

Re: Cage rest or fix? Cat pelvis

Dagmar Steele — Thu, 09 Feb 2012 17:22:25 GMT

depends on funds :-) If it was my own I'd fix it (have it fixed, to be more precise), most farm cats here would be 3. Which is fine, given it's a cat and they usually heal so well.

Re: Cage rest or fix? Cat pelvis

Mark Holmes — Thu, 09 Feb 2012 17:18:22 GMT