Sunday afternoon RTA fun

Re: Sunday afternoon RTA fun

Anthony Todd — Mon, 02 Feb 2015 23:26:53 GMT

Has it passed anything yet?

Re: Sunday afternoon RTA fun

Anthony Todd — Sun, 25 Jan 2015 00:30:11 GMT

[quote user="Hannah Wynne Richards"]

How would you return it? If leverage from outside,then fair enough. If pushing from the rectum, I'd be scared of penetrating the bowel.

Wynne

[/quote]

Sorry I missed this. True that's if the rectum isn't already penetrated [probably a rectal exam was done?] but I used not to push on the sharp bits but ant. or post. of them. in a fresh fracture they can be moved easily and seemed to stay in place.

Again, be nice to know what happened, and with an Xray and whether there's any constipation [tinned food might be a good idea?]

Re: Sunday afternoon RTA fun

Hannah Wynne Richards — Tue, 20 Jan 2015 09:45:14 GMT

How would you return it? If leverage from outside,then fair enough. If pushing from the rectum, I'd be scared of penetrating the bowel.

Wynne

Re: Sunday afternoon RTA fun

Anthony Todd — Mon, 19 Jan 2015 23:52:44 GMT

[quote user="Suzanne Kelly"]Yes I've seen then do fine with pelvises like that with just cage rest. [/quote]

Yes so have I but ,looking again at the Xray, it'll do better with that bone on the left pushed out of the way.

What's the disadvantage?

Re: Sunday afternoon RTA fun

Suzanne Kelly — Mon, 19 Jan 2015 23:33:52 GMT

Yes I've seen then do fine with pelvises like that with just cage rest. Mind you they didn't have paralysed front legs or abdominal hernias! Give the Os their options, if they want to give the little guy a chance with metacam and cage rest, why not? As long as they know it may be a pts job further down the line, no harm in giving him a fair chance.

Re: Sunday afternoon RTA fun

Anthony Dennison — Mon, 19 Jan 2015 17:55:42 GMT

[quote user="John Flynn"]

Tough call.

I'd be concerned about long-term pelvic narrowing and constipation/obstipation, and without a crystal ball to hand I'd be erring on the side of trying surgical intervention or some sort.

[/quote]

I'd have to agree with John here, concerns about the fibrosis when the pelvis heals in that position causing problems

Re: Sunday afternoon RTA fun

Anthony Todd — Mon, 19 Jan 2015 11:42:15 GMT

[quote user="Hannah Wynne Richards"] As far as surgery being better/worse then it all depends[/quote]

Quite often one can [or could] manipulate the pelvis to give an adequate pelvic canal PR, with a finger and a GA. Usually they sort of crunch back into some sort of normality.

It's an easy cheap fix and can be done, and we did it, under the X-ray GA.

+1 for the essential cage rest which means in a cage all the time for at least 3 weeks! [Then say it to the owner again and lend them a collapsible cage]

And don't be surprised when it "escapes" into the garden and the owner says "you didn't tell me not to let it go outside.....", particularly if the owner lived in Highgate!

Re: Sunday afternoon RTA fun

Hannah Wynne Richards — Mon, 19 Jan 2015 08:59:46 GMT

As far as surgery being better/worse then it all depends on David's skill. We're none of us in a position tojudge that. I certainly would prefer lifelong lactulose to me attempting this pelvis!

Wynne

Re: Sunday afternoon RTA fun

John Flynn — Mon, 19 Jan 2015 07:03:16 GMT

[quote user="David Mills"]What do people think about the L acetabulum?[/quote]

Growth plate I reckon.

I'd crack on with the right femoral head and neck excision personally (craniolateral approach through the skewed anatomy), but would definitely leave the left alone presently.

A transilial pin and even some small threaded pins and epoxy putty would not be very expensive, I still think stand a better chance of reasonable outcome with some attempt at reducing the pelvis... though I appreciate that can make things worse as well as better...

Re: Sunday afternoon RTA fun

David Mills — Sun, 18 Jan 2015 23:18:20 GMT

Unfortunately we don't offer pelvic surgery (charity), and the client has next to no money so referral is out. Owner is not even willing to consider PTS, but we'll see. Have people seen these heal successfully or are we looking at a lifetime of lactulose?

There was an abdominal wall rupture also (it's not obvious on the rads), that I repaired today. We took some better X-rays - which look no better (film, can't upload). The pelvis has stabilised itself in that position.

What do people think about the L acetabulum? Growth plate or fracture? Looking at 2 x FHNEs?

Re: Sunday afternoon RTA fun

Suzanne Kelly — Sun, 18 Jan 2015 23:03:25 GMT

+1 for cage rest.

Re: Sunday afternoon RTA fun

Stephen Courtney — Sun, 18 Jan 2015 22:14:41 GMT

I don't think that will do well without surgery, looks nasty.

Can take up to 3 month to assess nerve function recover but likely the left fore is a brachial plexus injury. Not a great day for this cat sadly.

Re: Sunday afternoon RTA fun

John Flynn — Sun, 18 Jan 2015 19:33:47 GMT

actually on thinking I'd prefer a few small ESF pins and epoxy putty, instead of the plate, placed in open fashion.

Re: Sunday afternoon RTA fun

John Flynn — Sun, 18 Jan 2015 19:20:36 GMT

Tough call.

I'd be concerned about long-term pelvic narrowing and constipation/obstipation, and without a crystal ball to hand I'd be erring on the side of trying surgical intervention or some sort.

What would I do?

I'm not sure, but perhaps a transilial pin (I'd avoid sticking anything into the sacrum on this kitten), right-sided femoral head and neck excision (oscillating saw rather than chiselling down with a mallet etc) and possibly a 2.0mm cuttable plate (even possibly malleable one might do?) laterally to join the front and back parts of right pelvis together. Hopefully the result would be a pelvic box a bit bigger than what you currently have (or what might result from further narrowing).

If I was doing something, I'd do it tomorrow.

I could of course make matters worse not better...

I'd be optimistic about the paralysed forelimb, is it unable to extend elbow as well as carpus? I'd give 6 weeks minimum before considering surgery there.

Re: Sunday afternoon RTA fun

Hannah Wynne Richards — Sun, 18 Jan 2015 17:49:53 GMT

If you're a super ortho-pod,then surgery is the ideal solution. If you're not confident - and I certainly wouldn't be with this injury, then as long as the bowel and rectal/bladder nerves are intact,then 6 weeks of strict cage rest and analgesia may work wonders. At least you haven't the problem of future kittening!

As for the front leg, if it remains paralysed, then amputation may be the best option, but wait at least a week 1st

Good luck.

Wynne