Will this fracture heal?

RE: Will this fracture heal?

Anthony Todd — Wed, 18 May 2016 01:50:21 GMT

See tangent

RE: Will this fracture heal?

David Mills — Wed, 18 May 2016 00:42:21 GMT

Update on case. Re-xrayed last week. Attached.

Cat using leg v well, only mild lameness, feels very sturdy, is off to new home this week. thanks for all input.

RE: Will this fracture heal?

Thomas Johnson — Sat, 02 Apr 2016 13:58:20 GMT

[quote user="Hannah Wynne Richards"]

Odd that Malcolm gets 5* and I get 1* - for writing exactly the same thing!

Wynne

[/quote]

I think it looked from your post as if you'd missed that the post suggesting a cast was a joke.

RE: Will this fracture heal?

Hannah Wynne Richards — Sat, 02 Apr 2016 08:44:24 GMT

Odd that Malcolm gets 5* and I get 1* - for writing exactly the same thing!

Wynne

RE: Will this fracture heal?

Thomas Johnson — Fri, 01 Apr 2016 18:51:28 GMT

[quote user="Iain Richards"]Whoops, forgot the "irony" button.[/quote]

Or is there an April Fool button?

RE: Will this fracture heal?

Hannah Wynne Richards — Fri, 01 Apr 2016 18:31:32 GMT

You need to immobilise the joints above and beneath. If it's non-painful, and stable, then I would simply cage rest with plenty of analgesia.

Wynne.

RE: Will this fracture heal?

Gillian Mostyn — Fri, 01 Apr 2016 15:45:05 GMT

[quote user="Iain Richards"]Surely if you cast the limb it will heal[/quote]

RE: Will this fracture heal?

Iain Richards — Fri, 01 Apr 2016 13:29:54 GMT

Whoops, forgot the "irony" button.

RE: Will this fracture heal?

Iain Richards — Fri, 01 Apr 2016 13:29:03 GMT

Surely if you cast the limb it will heal

RE: Will this fracture heal?

David Mills — Fri, 01 Apr 2016 11:18:47 GMT

Thanks Malcolm. Good to have your input back on the forum.

There is a considerable callus present and the fragments don't appear to move - obviosuly it looks odd. Cat is around 4/10 lame on the leg, but bears weight on it well and as before moves around happily and jumps/explores. As said, I wouldn't have expected such soundness from the rads hence the question about whether anything was needed; good to hear conservatism is a viable option. Ex-fixs are difficult here in terms of maintenance and don't have locking plates. Feeling the callus it would be a big job.

[quote user="Martin Atkinson"]Given I suspect this is a charitable case and it looks like its healing then Malcolm's first choice seems the way to proceed.[/quote]

Quite so, although we'll fix fractures in strays if required.

[quote user="Martin Atkinson"]I might have known it was a ringer from you or I didn't spot the gorilla on the stage and just looked at the pelvis.[/quote]

RE: Will this fracture heal?

Martin Atkinson — Fri, 01 Apr 2016 10:42:15 GMT

[quote user="David Mills"]Ha yep, but I was talking about the femur...[/quote]I might have known it was a ringer from you or I didn't spot the gorilla on the stage and just looked at the pelvis. Given I suspect this is a charitable case and it looks like its healing then Malcolm's first choice seems the way to proceed.

RE: Will this fracture heal?

Hannah Wynne Richards — Fri, 01 Apr 2016 08:39:31 GMT

Expert's opinion from Malcolm - 1st do no harm

I agree

Wynne

RE: Will this fracture heal?

Malcolm Ness — Fri, 01 Apr 2016 07:41:22 GMT

There are several fractures here: R ischium; R pubis; L scaro-iliac separation and the obvious long spiral fracture of the femur. The clinical observations of a mobile, functional and comfortable cat and an obvious fibrous callus along with radiographic features (loss of 'sharpness' of fragments and no obvious soft tissue swellings) suggest that this set of injuries is more than just a few days old.

All three pelvic fractures are only slightly displaced and the functional outcome will not be measurably improved with surgery so I would leave them alone.

Two options for the femur:

1.leave it alone - it is healing in malunion but there is little bending or rotational deformity, only shortening. Although this will leave the cat with a gait abnormality it is likely to cope very well - good function and pain-free. The healing process has a long way yet to run so you can confidently expect to see this cat continuing to improve for several weeks yet.

2. open reduction and surgical fixation. Despite what has been implied in previous posts, that option will be technically challenging. Although there is not a lot to see radiographically, a callus that is supporting weight bearing and can be felt by the veterinary surgeon is enough to make surgical reduction extremely difficult. These fragments will not mobilise easily and the surgical dissection/manipulation implied will set back bone healing substantially. At the very least it will be time-consuming - it will take a long time to stretch out those contracted muscles. Fixation with a simple IM pin in this fracture now would be a mistake and even when it was fresh, a pin would have been sub-optimal. At the very least, a series of cerclage wires would have been needed to control rotation and shortening after IM pinning. Better would have been (and would now be) pin plus Ex fix or pin plus locking plate.

Certainly, good surgery could offer a better cosmetic and better functional outcome than conservatism but it will be costly, time-consuming, uncomfortable and associated with a substantial risk of making things very much worse.

RE: Will this fracture heal?

David Mills — Thu, 31 Mar 2016 20:39:10 GMT

[quote user="Martin Atkinson"]

So long as it can weight bear and defaecate then it will be fine, anyway it sounds as though its already healed. As one orthopod said: 'nothing lends itself less to surgery and more to surgical complications than a fractured pelvis'.

[/quote]

Ha yep, but I was talking about the femur...

Re other replies it is rather tempting to pin it but the mobility and comfort of this cat is phenomenal despite the rads. We keep strays for 7 days before non-emergency interventions so it's a bit of a head scratcher.

RE: Will this fracture heal?

Mark Hedberg — Thu, 31 Mar 2016 19:14:34 GMT

Pin the femur, cage rest, seen worse, it'll be fine ;)

RE: Will this fracture heal?

John Flynn — Thu, 31 Mar 2016 19:10:59 GMT

i would expect this to form bony union most likely if left to nature, but im not sure i could resist a pin and cerclage wire on that femur.

Medullary canal appears open and fracture ends sharp, so I don't think it's that old - maybe 3 weeks?

if its genuinely very mobile on limb (not just lame on both hindlimbs) and very stable femur under ga and patella tracks fine etc and i thought would be a fair dissection job to line it up again, id leave it as is with view to breaking and plating if encountered problems down the line.

RE: Will this fracture heal?

Emily Rainbow — Thu, 31 Mar 2016 18:16:49 GMT

have you got a lateral pelvis?

although I would prob agree with Martin but I'm not so sure about the femur I'd wait an orthopod respond! Although logic would say if it's doing that well rest and analgesia may be an option If it's stable and the owners don't mind a mechanical lameness.

RE: Will this fracture heal?

Martin Atkinson — Thu, 31 Mar 2016 18:08:45 GMT