Management of Pelvic Trauma

Urethral entrapment by an overlapping dislocation of the pubic symphysis in a cat

Case summary

A 1-year-old neutered male domestic shorthair cat was referred with suspected uroperitoneum. Ultrasonography showed peritoneal effusion. CT further revealed a bilateral sacroiliac joint disruption associated with an overlapped dislocation of the pubic symphysis, resulting in an abnormal trajectory of the urethra with extramural urethral compression. An open reduction and internal fixation of the pubis with correction of the urethral trajectory was performed under general anaesthesia. The uroperitoneum was determined to originate from a cystocentesis.

Relevance and novel information

This report describes an unusual case of urethral obstruction secondary to overlapping dislocation of the pubic symphysis with urethral entrapment and concurrent bilateral sacroiliac luxation. To the authors' knowledge, acute urethral obstruction owing to fractures of the pubis, without urethral laceration, has never been described.

Use of Locking Plates Fixed with Cortical Screws for Pelvic Fracture Repair in 20 Cats

OBJECTIVE

 The aim of this study is to describe the use of String of Pearls (SOP) plates for the surgical management of feline pelvic fractures, including surgical technique, proposed indications, complications, and outcomes in a cohort of cats.

STUDY DESIGN

 This study is a single-center retrospective clinical case series.

METHODS

 Medical records (2015-2019) of cats presenting for pelvic fractures (n = 33) were reviewed. Type of fracture, preoperative and postoperative imaging, and complications were retrospectively retrieved. Owners were contacted via questionnaire for medium- and long-term follow-up.

RESULTS

 A total of 20 cats met the inclusion criteria. Minor intraoperative complications were encountered in three patients. One patient suffered a major intraoperative complication. Five major complications were encountered postoperatively. These included two greater trochanter osteotomy fixation implant removal and three SOP plate removal. Full function was recovered in all patients according to the owners' assessment.

CLINICAL SIGNIFICANCE

 The use of SOP plates in feline pelvic fractures appears to yield a consistently good outcome with a very low incidence of canal narrowing and screw loosening. SOP plates are easy to contour and to apply along the entire pelvic length.

Urinary Tract Trauma in Cats: Stabilisation, Diagnosis and Management

PRACTICAL RELEVANCE

Traumatic injury of the urinary tract may be caused by external accidental trauma or due to iatrogenic injury (typically as a result of catheterisation procedures). Thorough patient assessment and careful attention to patient stabilisation are essential, with diagnosis and surgical repair delayed until the patient is stable, if necessary. Treatment depends on the location and severity of the trauma. If diagnosed and treated promptly, the chance of survival of a patient without other concurrent injuries is good.

CLINICAL CHALLENGES

Following accidental trauma, at the initial presentation urinary tract injury can be overshadowed by other injuries, but if left undiagnosed or untreated it can lead to serious morbidity and potentially mortality. Many of the surgical techniques described for management of urinary tract trauma can be associated with complications, and so comprehensive communication with the owners is necessary.

PATIENT GROUP

The main population affected by urinary tract trauma is young, adult male cats, owing to their roaming behaviour, as well as their anatomy and the resulting increased risk of urethral obstruction and its associated management.

AIMS

This article aims to serve as a guide to all veterinarians who treat cats for the diagnosis and management of urinary tract trauma in cats.

EVIDENCE BASE

This review summarises the current knowledge available from a number of original articles and textbook chapters in the literature that cover all aspects of feline urinary tract trauma, and is supported by the authors' own clinical experience.

Locking Compression Plate Fixation of Feline Acetabular Fractures: Application, Complications and Perioperative Outcome

OBJECTIVES

 The aim of this study was to report the use, complications and perioperative outcome of locking compression plates (LCP) for acetabular fracture fixation in feline patients.

STUDY DESIGN

 Medical records were reviewed for cats presented with acetabular fractures between 2011 and 2019. Only cases that involved open reduction and internal fixation with at least one LCP and had a minimum of 5-week postoperative follow-up were included. Long-term follow-up was based on the Feline Musculoskeletal Pain Index.

RESULTS

 Fifteen cats with 15 acetabular fractures met the inclusion criteria. Locking compression plates were used as a sole method of fixation in 11/15 cases, while with other ancillary implants in 4/15 cases. There were two minor complications related to the LCP consisting of a single screw backing out. Two major perioperative complications not related to the locking implants were described and required further surgical treatment. At the last clinical follow-up (median 46 days: 38-88 days), function was described as full for 7/15 cats, and acceptable for 8/15 cats. The Feline Musculoskeletal Pain Index questionnaire was completed by 9/15 owners at a median of 2,332 days; all owners reported their cats had minimal impairment.

CLINICAL SIGNIFICANCE

 Based on our results, LCP is a suitable implant for acetabular fracture fixation in cats, associated with a satisfactory outcome. Complications were similar to previously reported with other methods.

Feline Femoral Fracture Fixation: What are the options?

PRACTICAL RELEVANCE

The femur is the most commonly fractured bone in cats. Femoral fractures usually result from high-velocity trauma such as a road traffic accident or fall from a height and, as such, are associated with a wide variety of concurrent injuries. The initial focus of treatment should always be on assessment and stabilisation of the major body systems. Once any concurrent injuries have been addressed, all femoral fractures need surgical stabilisation, with the notable exception of greenstick fractures in very young cats, which can heal with cage rest alone. A number of different surgical options are available depending on the fracture type, location, equipment, surgeon experience and owner finances.

CLINICAL CHALLENGES

Femoral fractures can vary hugely in complexity and the small size of feline bones can limit the choice of implants. Furthermore, cats can present unique challenges in the postoperative period due to their active nature and the limited means to control their exercise level.

AUDIENCE

This review is aimed at general and feline-specific practitioners who have some experience of feline orthopaedics, as well as those simply wishing to expand their knowledge.

AIMS

The aim of this review is to help clinicians assess, plan and manage feline femoral fractures. It provides an overview of diagnostic imaging and a discussion of a range of suitable surgical options, including the principles of different types of fixation. It also highlights cat-specific issues, approaches and implants pertinent to the management of these cases.

EVIDENCE BASE

A number of original articles and textbook chapters covering many aspects of femoral fractures in cats and dogs have been published. Where possible, this review draws on information from key feline research and, where necessary, extrapolates from relevant canine literature. The authors also offer practical guidance based on their own clinical experience.

Evaluation of a screw insertion landmark for a minimally invasive repair technique in induced bilateral sacroiliac luxation in feline cadavers

OBJECTIVES

The aim of this study was to describe an alternative landmark for screw insertion into the body of the ilium with bilateral sacroiliac luxation in cats.

METHODS

Seven cat cadavers with artificially induced bilateral sacroiliac luxation were used. The screw insertion point was determined using the caudal iliac crest and cranial acetabular rim. These two points make the first guideline; a second guideline ran perpendicular to the caudal iliac crest point. The screw insertion point was halfway along the second guideline across the ilium body. Surgery was performed in a minimally invasive manner using fluoroscopy.

RESULTS

Postoperative radiographs and CT were performed. In the postoperative evaluation, the sacroiliac joint reduction percentage was almost 90% and there was no significant difference in pelvic canal diameter ratio before and after surgery. Screw depth/sacral width was >60% in all cadavers. On CT, the angle between the screw and sacrum wing was within the normal range of 96.24° to the left and 98.65° to the right, except in one case.

CONCLUSIONS AND RELEVANCE

In previous studies, surgical repair was based on having an intact contralateral ilium. However, this method is not applicable to patients with bilateral sacroiliac luxation and is mostly performed using open reduction methods. The screw insertion point suggested in this study offers a potential alternative repair technique for patients with bilateral sacroiliac luxation.

An unusual case of traumatic dorsolateral sacral hernia with retroflexion of the urinary bladder in a cat

Background:

Perineal hernias are rarely seen in cats and can be caused by congenital or trauma. The urinary bladder is the most herniated organ and was being observed in prepubic, ventral perineal, umbilical, or caudoventral abdominal regions.

Case Description:

A 1-year-old female domestic short-haired cat was presented to the Animal Hospital of the Near East University Faculty of Veterinary Medicine with complaints of urinary retention as well as the inability to defecate. The patient owner reported that the cat had been struck by a car around 4 months previously, which resulted in a pelvic fracture. On clinical examination, a fluctuating mass was detected in the dorso-lateral region of the pelvis. After radiographic and ultrasonographic examination, the mass was diagnosed as the urinary bladder. A cystopexy operation was performed on the urinary bladder, which herniated through a muscular tear to the right dorsolateral pelvic region.

Conclusion:

Unusual case report of a sacral hernia resulting from a traumatic rupture of the sacral muscles together with urinary bladder retroflexion was reported in a cat.

Ex vivo comparison of lateral plate repairs of experimental oblique ilial fractures in cats

OBJECTIVE

To determine the biomechanical behavior of different plate systems used for oblique ilial fracture fixation in cats.

STUDY DESIGN

Ex vivo biomechanical study.

SAMPLE POPULATION

Fifty fresh-frozen feline hemipelvises.

METHODS

Standardized simple oblique ilial fractures were created and fixed via lateral plating, using different implant systems (10 fractures in each group) The systems were: (1) the Advanced Locking Plate System (ALPS-5); (2) the Advanced Locking Plate System (ALPS-6.5); (3) the Locking Compression Plate 2.0 (LCP); (4) the FIXIN 1.9-2.5 Series (FIXIN), and (5) the Dynamic Compression Plate 2.0 (DCP). Stepwise sinusoidal cyclic loading was applied until failure (10-mm displacement). The groups were compared with regard to construct stiffness and the number of cycles withstood before 1-, 2-, 5-, and 10-mm displacement.

RESULTS

Bending stiffness was lower in ALPS-5 than in other specimens (P < .05). The ALPS-6.5 specimens withstood more cycles (P < .05) before 2-, 5-, and 10-mm displacement than the ALPS-5 and DCP specimens . The LCP and FIXIN specimens endured more cycles than DCP specimens before displaying 5- and 10-mm displacement (P < .05). The ALPS-6.5, FIXIN, and LCP specimens endured higher loads before failure than the DCP specimens (P < .05). Screw loosening occurred in all nonlocking specimens, and bone slicing occurred in all locking specimens.

CONCLUSION

The DCP and ALPS-5 constructs are less resistant to cyclic loading. Failure in nonlocking specimens involved screw loosening. It involved bone slicing in locking specimens.

CLINICAL SIGNIFICANCE

Both the plate size and the plate-screw interface are key to lateral plating success in cases of feline ilial fractures. The use of locking plates reduces the risk of the screw loosening in such cases.

Outcomes of nine cats with urinary retention after sacrocaudal luxation managed with long-term urinary diversion

OBJECTIVE

To document the outcomes of cats with urinary retention (UR) after sacrocaudal luxation (SCL) and managed with a long-term cystostomy (LTC).

STUDY DESIGN

Short case series.

ANIMALS

Nine client-owned cats with SCL and subsequent UR.

METHODS

Nine cats suffering from non-relievable UR secondary to SCL, between March 2013 and December 2020, had a LTC placed 4.5 days post-SCL (mean, range 3.5-6.0), until clinical evidence of normal urination recovery. The bladder was emptied at least twice daily. No antimicrobial was given during LTC. Indication for tube removal was voluntary micturition with complete emptying for a minimum of three consecutive days. Recheck examinations were scheduled for post-SCL days 7 and 14, as well as for LTC tube removal. Minor and major complications and length of LTC use were recorded.

RESULTS

The LTC was removed 11-42 days (mean 26 days) after placement. All cats recovered normal micturition spontaneously within 17-47 days post-SCL (mean 30.7 days): 1 cat between the 2nd and 3rd weeks, 5 cats between the 3rd and 4th weeks, and 3 cats >30 days after the trauma. Major complications, such tube dislodgement, occurred in two cats, whereas complications resolving after tube removal were recorded in 6 cats.

CONCLUSION

LTC was effective at managing UR post-SCL in 9 cats. All cats recovered normal urinary function within 7 weeks.

CLINICAL SIGNIFICANCE

LTC can be an alternative to manual expression or bladder catheterization in cats with temporary UR after SCL.

Comparison of Single versus Double Lateral Plating in Treatment of Feline Ilial Fractures Using Veterinary Cuttable Plates

OBJECTIVE

 The aim of this study was to compare the frequency of implant failure and the extent of pelvic canal narrowing associated with the fixation of ilial fractures in cats with a single veterinary cuttable plate (SLP) or double veterinary cuttable plates (DLP) applied to the lateral surface of the ilium.

STUDY DESIGN

 Radiographic evaluation of feline ilial fractures plated laterally using SLP or DLP. Pelvic canal narrowing directly postoperatively and at 6 weeks follow-up was objectively measured using the sacral index (SI). Radiographs were evaluated for implant failure and fracture healing.

RESULTS

 Seventy-seven cats satisfied the inclusion criteria. Twenty-nine fractures were treated with a SLP and 48 with DLP. Implant failure occurred significantly more (p = 0.001) in the SLP group (14/29) compared with the DLP group (6/48). Follow-up SI was significantly different between the two groups (p = 0.048, SLP median: 1.0 range: 0.83-2.4, DLP median: 0.98; range: 0.76-1.45). Median change in SI was -0.04 (range: -1.4-0.05) in the SLP group and 0.0 (range: -0.23-0.23) in the DLP group. This difference was significantly different (p = 0.031).

CONCLUSION

 DLP leads to significantly less implant failure and significantly less pelvic canal narrowing compared with SLP. This difference in pelvic canal narrowing was small and the clinical relevance remains unclear.

Defining a safe corridor for trans-iliac pin placement in cats

OBJECTIVE

To identify whether a theoretical predictable safe corridor is available in cats for placement of trans-iliac pins without the use of fluoroscopy.

METHODS

Twenty-one cats with straight orthogonal normal pelvic radiographs were included. Two start points were evaluated: a midpoint and a dorsal point. The midpoint was defined as midway between the dorsal lamina of the sacral vertebral canal and the cranial dorsal iliac spine. The dorsal start point was 2 mm ventral to the cranial dorsal iliac spine. The pin was assumed to be driven at 90 degrees to the lateral face of the ilium, and considered surgeon accuracy was ±4 degrees from the perpendicular. The angular range and the distance between the iliac wings from the ventrodorsal radiograph were used to calculate the possible cross-sectional area and pin exit location if driven from one iliac wing to the other. The corridor was then evaluated for repeatability in six randomly selected cats.

RESULTS

Vertebral foramina penetration risk was identified in some cats when using a 1.6 and 2 mm-diameter pin using the mid-iliac wing start point. The dorsal start point decreased the available pin placement area but reduced the risk of entering the hazardous zone for all pin sizes up to 2 mm.

CONCLUSION AND RELEVANCE

A theoretical defined safe corridor is available for trans-iliac pin placement in cats between 2.0 and 5.5 kg. A 1.2-mm pin is the safest if using the mid-iliac wing start point. A more dorsal start point can accommodate up to a 2.0-mm pin if correctly aligned to the sacrum.

Treatment of pelvic fractures in cats with patellar fracture and dental anomaly syndrome

Objectives

The aim of this study was to describe the treatment and outcome of acetabular and other pelvic fractures in cats with patellar fracture and dental anomaly syndrome (PADS) and to provide advice on how to manage these cases in practice.

Methods

Data were collated on cats with PADS that were reported to have sustained pelvic fractures or had fractures or fissures of the pelvis identified on submitted radiographs. The details of the fractures were recorded, in addition to any treatment and outcome information.

Results

Of the 215 cases reported with PADS, 58 cats (27%) were found to have pelvic fractures, none of which were known to have resulted from significant trauma. There were 101 fractures in total and of these 15 were treated with surgery, including 10 acetabular fractures, two ilial, two pubic and one ischial fracture. Screw loosening and loss of fracture reduction was seen in four of the surgically treated fractures (two pubic fractures, one ilial and one acetabular fracture). Fourteen cats were euthanased as a direct result of a fracture occurring. While most pelvic fractures healed uneventfully, some cats remained intermittently lame, but it was not always possible to determine the cause of the lameness from the information available and because all cats had concurrent patellar fractures.

Conclusions and relevance

Many of the pelvic fractures healed with conservative management. Fractures involving articular surfaces such as acetabular fractures may benefit from surgical stabilisation as surgery may offer the benefits of articular fracture repair with improved joint congruency and a faster return to normal activity.

Conservative management of pelvic fractures in dogs and cats in Algiers: Incidence and long-term clinical outcomes

Aim:

We performed a retrospective study to evaluate clinical complications and outcomes associated with non-operative management of pelvic fractures in dogs and cats and described owner satisfaction.

Materials and Methods:

Based on radiographic findings and fracture location, case records were classified into two groups. Group 1 included animals with acetabulum involvement that underwent conservative treatment plus femoral head-and-neck excision. Group 2 included animals without acetabulum involvement that underwent conservative treatment only. Compliance with rest instructions, time to locomotion recovery, and the evaluation of persistent lameness were data collected from the questionnaire. The level of satisfaction was classified as excellent, good, or bad. Clinical outcome was evaluated at least 10 months after the fracture.

Results:

Pelvic injuries included sacroiliac luxations (59.52%) and ilial body (35.7%), acetabular (21.4%), pubic (21.4%), and ischial (14.28%) fractures alone or combined. According to the owners, the proposed strategy yielded good to excellent outcomes in dogs and cats in this study, with 95.23% of animals regaining full function of their hind limbs. Two dogs had slight chronic lameness, and some degree of gait abnormality persisted.

Conclusion:

Because of financial constraints, the chronicity of fractures, or lack of surgical techniques, the surgical treatment of pelvic fractures may not be possible. Non-operative treatment can then be considered to allow the animal to return to acceptable function.

Evaluation of prognostic factors for return of urinary and defecatory function in cats with sacrocaudal luxation

OBJECTIVES

The aim of this study was to evaluate outcomes and prognostic factors for cats with sacrocaudal luxation.

METHODS

Medical records and radiographs were reviewed for cats with sacrocaudal luxation. Information obtained from the clinical records included signalment, clinical presentation, concurrent traumatic injuries, treatment details, outcome and survival time. Severity of neurological signs was graded from 1 to 5, based on previous grading systems for cats with sacrocaudal luxation. Degree of vertebral displacement was calculated on survey radiographs. Outcomes were collected from serial neurological examinations and telephone interviews. Cats had to be given a minimum of 30 days to regain urinary function to be included in the study.

RESULTS

Seventy cats were included. Fifty-five of 61 cats (90%) regained voluntary urinary function. A higher neurological grade was associated with a decreased likelihood (P = 0.01) and longer duration (P = 0.0003) of regaining urinary function. No significant associations were found between urinary outcome and age, sex, anal tone, perineal sensation, tail base sensation, degree of craniocaudal or dorsoventral sacrocaudal displacement, concurrent orthopaedic injury, tail amputation, defecatory function at diagnosis and survival. Cats that regained defecatory function had longer survival times than those that did not recover defecatory function (P = 0.03). Defecatory outcome was not significantly associated with any other variables.

CONCLUSIONS AND RELEVANCE

In agreement with previous studies, neurological grade is the most important prognostic indicator for cats with sacrocaudal luxation. Determination of the severity of neurological signs can also aid in advising owners the time frame in which urinary function is expected to return. Faecal incontinence may be a more important prognostic factor than previously suspected.

Conservative management of sacroiliac luxation fracture in cats: medium- to long-term functional outcome

OBJECTIVES

The aim of this study was to determine the functional medium- to long-term outcome for cats with a conservatively managed sacroiliac luxation fracture (SILF).

METHODS

Inclusion criteria were conservative management of SILF in cats with no other concurrent fractures of the pelvic weightbearing axis and availability of radiographs for review. Radiographic measurements of percentage displacement of the sacroiliac joint and the sacral index were obtained and fracture configuration was assessed. A specific owner questionnaire was completed a minimum of 6 months after the injury. The questionnaire assessed the ability of the cat to perform normal activities, the time to recovery, any behavioural changes and any requirement for long-term analgesia.

RESULTS

Seventeen cats met the inclusion criteria, and 13 owners completed the questionnaire. Twelve cats had an excellent outcome, with no difficulty performing normal activities. One cat had a good outcome, with slight or occasional difficulty performing normal activities.

CONCLUSIONS AND RELEVANCE

Our study provides evidence to support the current guidelines of conservative management of SILF. The inherent bias of case selection in our population implies that this treatment cannot be recommended for all cases of SILF.

Predictors of comorbidities and mortality in cats with pelvic fractures

OBJECTIVE

To characterize and evaluate risk factors for comorbidities and death of cats with pelvic fractures.

STUDY DESIGN

Retrospective case study.

ANIMALS

Cats (n = 280).

METHODS

Medical records were reviewed for cats in which pelvic fractures had been diagnosed (January 2003 to November 2016). Retrieved data included signalment, mechanism of injury, clinical findings, diagnostic imaging investigations, type and number of concurrent injuries based on anatomical location, type of therapy, and survival. Pelvic fractures were classified according to location and severity. Descriptive statistics were performed, and logistic regression models were constructed to examine associations between risk factors and outcome.

RESULTS

Cases consisted of 280 cats with no (9%), unilateral (43%), and bilateral (48%) involvement of the weight-bearing axis. Sacral fractures were found in 12% of cats. Surgical treatment and mortality rates increased progressively with the severity of the pelvic fractures (P < .001). Mean number of concurrent body regions injured was 2.4 ± 1.2 and was associated with mortality (P < .01). Twenty percent of cats did not survive to discharge. Cats with neurologic injuries were more likely not to survive (P = .02).

CONCLUSION

Concurrent injuries to at least one body region, especially the abdomen and thorax, were observed in cats sustaining pelvic fractures. Mortality was associated with increased severity of the fractures, neurologic injuries, and increased number of concurrent injuries.

CLINICAL SIGNIFICANCE

Concurrent injuries are common in cats with pelvic fractures, and comorbidities may be associated with mortality.

Retrospective evaluation of factors influencing transfusion requirements and outcome in cats with pelvic injury (2009-2014): 122 cases

OBJECTIVE

To characterize a population of cats with pelvic trauma and evaluate factors influencing transfusion requirement and outcome.

DESIGN

Retrospective case series (2009-2014).

SETTING

University teaching hospital.

ANIMALS

One hundred twelve client-owned cats with pelvic trauma.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Twenty-one (18.8%) cats received a transfusion. Most cats required only 1 fresh whole blood transfusion (85.8%). Packed cell volume at admission was significantly lower in cats that required transfusion but was not associated with hospitalization time or survival to discharge. Increasing Animal Trauma Triage (ATT) score at admission was significantly associated with transfusion requirement (P = 0.0001) and nonsurvival to discharge (P = 0.03). Number of pelvic fractures was not associated with transfusion requirement but cats with sacroiliac luxations and pubic fractures were more likely to require a transfusion (P = 0.0015 and P = 0.0026, respectively). However, fracture type was not associated with survival to discharge. Most cats (86%) required a surgical procedure and half of transfusions were administered preoperatively. No surgical comorbidities were associated with transfusion requirement or survival. Transfusion requirement was associated with longer length of hospitalization but not survival to discharge.

CONCLUSIONS

Transfusion requirement in this population of cats with pelvic fractures was fairly high. Transfusion requirement was associated with lower packed cell volume, higher ATT score at admission, longer length of hospitalization, and certain types of pelvic fractures. Transfusion requirement was not associated with surgical comorbidities, surgical intervention, or survival to discharge. Lower ATT score at admission was associated with survival to discharge.

Outcome of surgical stabilisation of acetabular fractures in 16 cats

OBJECTIVES

The aim of this study is to describe the presentation, surgical management and perioperative outcome of cats with acetabular fractures.

METHODS

Case records and radiographs of cats with acetabular fractures were reviewed from presentation to the end of follow-up. Surgical technique, complications, radiographic reduction and the presence of neurological deficits were recorded.

RESULTS

Sixteen cats with 17 acetabular fractures met the inclusion criteria. All fractures were associated with concurrent orthopaedic injuries. All cats were either moderately or severely lame on presentation. Five fractures were stabilised using screws, wire, pins and polymethylmethacrylate, nine were repaired using a straight dynamic compression plate and three were repaired using a locking plate. Two of seven cats that were neurologically normal prior to surgery developed transient neuropraxia following surgery. There were three major complications and no minor complications. At the end of follow-up 3/16 cats had full function, whereas 13/16 had acceptable function.

CONCLUSIONS AND RELEVANCE

All cats undergoing surgical stabilisation of acetabular fractures returned to full or acceptable function by the end of the follow-up period and there was a low number of intraoperative and short-term complications. Neurological deficits were common preoperatively, but the majority of these deficits had resolved by follow-up.

Partial internal hemipelvectomy as rescue therapy in obstipation in four dogs: case report

ABSTRACT Multiple pelvic fractures can lead to narrowing of the pelvic canal and loss of life quality. Hemipelvectomy, characterized by removal of bone fragments from the pelvis, is considered a rescue therapy. This report describes the technique of caudal partial hemipelvectomy in four cases of obstipation secondary to traumatic pelvic canal narrowing in four dogs, with promising results. All patients had tenesmus and fecal retention. After the procedure, the patients presented immediate normochezia and support of the ipsilateral limb after 10 to 20 days, showing the feasibility of the technique in small animals, providing clinical improvement without walking alterations.

Use of computed tomography to define a sacral safe corridor for placement of 2.7 mm cortical screws in feline sacroiliac luxation

Objectives This study aimed to define a safe corridor for 2.7 mm cortical sacroiliac screw insertion in the dorsal plane (craniocaudal direction) using radiography and CT, and in the transverse plane (dorsoventral direction) using CT in feline cadavers. A further aim was to compare the values obtained by CT with those previously reported by radiography in the transverse plane. Methods Thirteen pelvises were retrieved from feline cadavers and dissected to expose one of the articular surfaces of the sacrum. A 2.7 mm screw was placed in the sacrum to a depth of approximately 1 cm in each exposed articular surface. Dorsoventral radiography and CT scanning of each specimen were performed. Multiplanar reconstructions were performed to allow CT evaluation in both the dorsal and transverse planes. Calculations were made to find the maximum, minimum and optimum angles for screw placement in craniocaudal (radiography and CT) and dorsoventral (CT) directions when using a 2.7 mm cortical screw. Results Radiographic measurement showed a mean optimum craniocaudal angle of 106° (range 97-112°). The mean minimum angle was 95° (range 87-107°), whereas the mean maximum angle was 117° (108-124°). Measurement of the dorsal CT scan images showed a mean optimum craniocaudal angle of 101° (range 94-110°). The mean minimum angle was 90° (range 83-99°), whereas the mean maximum angle was 113° (104-125°). The transverse CT scan images showed a mean dorsoventral minimum angle of 103° (range 95-113°), mean maximum angle of 115° (104-125°) and mean optimum dorsoventral angle of 111° (102-119°). Conclusions and relevance An optimum craniocaudal angle of 101° is recommended for 2.7 mm cortical screw placement in the feline sacral body, with a safety margin between 99° and 104°. No single angle can be recommended in the dorsoventral direction and therefore preoperative measuring on individual cats using CT images is recommended to establish the ideal individual angle in the transverse plane.

Evaluation of the use of intra-operative radiology for open placement of lag screws for the stabilization of sacroiliac luxation in cats

Objectives: To assess the effect of intra- operative radiology on the quality of lag screw insertion for the management of sacroiliac joint luxations in cats.

Methods: In this retrospective single-centre study, the surgical, anaesthetic and imaging records of 40 screws (32 cats) placed with lag effect for management of sacroiliac luxation were reviewed. Postoperative radio-graphs were assessed for sacroiliac joint reduction, screw position, and sacral width purchased by each screw. Cases were divided into two groups according to the use of (IOR) or the absence of intra-operative radiology (NIOR).

Results: A total of 23 lag screws were placed with the aid of intra-operative radiology and 17 without. Three of the 23 screws placed in the IOR group exited the sacrum as opposed to eight of 17 screws in the NIOR group (p = 0.03). Mean sacral width purchased by the screws in the IOR group (70.8%) was also significantly higher (p = 0.002) than in the NIOR group (54.6%). Mean general anaesthetic times for unilateral and bilateral screw placement for the IOR group and NIOR group were not significantly different.

Clinical significance: The use of intra-operative radiology can significantly improve the quality of lag screw insertion for the stabilization of sacroiliac luxations in cats, which should lead to a reduced incidence of postoperative screw loosening.

Dynamic chronic rectal obstruction causing a severe colonic dilatation in a cat

CASE SUMMARY

A 5-year-old male neutered domestic shorthair cat was presented to our referral centre with a 13 month history of chronic tenesmus due to malunion of the right caudal iliac body. Constipation and pelvic canal stenosis were initially addressed by the referring veterinarian with a right femoral head and neck excision and a right acetabulectomy without observable clinical improvement. At admission, abdominal radiographs revealed severe colonic distension and a narrowed pelvic canal caused by the right proximal femur. Rectal examination and colonography revealed a dynamic compression of the rectum, which worsened with femoral abduction and improved with femoral adduction. A right hindlimb amputation was performed to relieve the obstruction. The cat defaecated 2 days postoperatively and was discharged uneventfully. Neither faecal tenesmus nor dyschaezia were observed over the following 10 months.

RELEVANCE AND NOVEL INFORMATION

The dynamic nature of the rectal obstruction most likely prevented the development of an irreversible colonic dilatation leading to a megacolon. This is the first report describing a chronic dynamic rectal compression, which was successfully managed with a right hindlimb amputation without the need for subtotal colectomy.

Management and long-term outcome of pelvic fractures: a retrospective study of 43 cats

Objectives The aim of the study was to evaluate the management and long-term outcome of cats with pelvic fractures. Methods Cats with pelvic fractures had their records and radiographs reviewed. Radiographs were reviewed for fracture configuration, implants and pelvic canal narrowing. Owners were contacted for long-term follow-up. Results Forty-three cats met the criteria (mean follow-up 24 months [range 6-45 months]). The majority (93%) had more than one orthopaedic pelvic injury, with sacroiliac fracture luxations seen most commonly; 23% had presurgical neurological deficits. Most cats (74%) were managed surgically; 60% of sacroiliac fracture luxations, 82% of ilial fractures and 50% of acetabular fractures received surgery. The complication rate was 22%, most commonly sciatic neurapraxia (13%). Seventy-nine percent of all neurological deficits resolved and the remainder improved. Mean pelvic canal narrowing after trauma was -15% in surgical and -16% in conservatively managed cats. Canal width was improved postoperatively (-8%) but mildly narrowed further by follow-up (-12%); however, these changes were not significant. Nineteen percent of cats had constipation postsurgery; none developed megacolon. There was no clear correlation between the degree of narrowing of the pelvic canal up to -50%, or whether conservative treatment was opted for, and the development of constipation. Long-term mobility was not impaired in 86% of cats, and 84% did not have any lameness detectable. Conclusions and relevance The majority of cats were managed surgically, with a 22% complication rate; the most common being transient sciatic neurapraxia. Long-term outcome was generally excellent and most had a full recovery. Constipation/obstipation was very uncommon and no clear relationship with pelvic canal narrowing could be found when considering narrowing of up to -50% in both surgical and conservative groups. As no cats in this cohort had narrowing greater than -50%, the current recommendation of surgery to improve the canal width if narrowing is greater than -45% to -50% should remain.

Evaluation of the diagnostic accuracy of four-view radiography and conventional computed tomography analysing sacral and pelvic fractures in dogs

OBJECTIVE

The purpose of our study was (1) to determine whether four-view radiography of the pelvis is as reliable and accurate as computed tomography (CT) in diagnosing sacral and pelvic fractures, in addition to coxofemoral and sacroiliac joint subluxation or luxation, and (2) to evaluate the effect of the amount of training in reading diagnostic imaging studies on the accuracy of diagnosing sacral and pelvic fractures in dogs.

METHODS

Sacral and pelvic fractures were created in 11 canine cadavers using a lateral impactor. In all cadavers, frog-legged ventro-dorsal, lateral, right and left ventro-45°-medial to dorsolateral oblique frog leg ("rollover 45-degree view") radiographs and a CT of the pelvis were obtained. Two radiologists, two surgeons and two veterinary students classified fractures using a confidence scale and noted the duration of evaluation for each imaging modality and case. The imaging results were compared to gross dissection.

RESULTS

All evaluators required significantly more time to analyse CT images compared to radiographic images. Sacral and pelvic fractures, specifically those of the sacral body, ischiatic table, and the pubic bone, were more accurately diagnosed using CT compared to radiography. Fractures of the acetabulum and iliac body were diagnosed with similar accuracy (at least 86%) using either modality.

CLINICAL SIGNIFICANCE

Computed tomography is a better method for detecting canine sacral and some pelvic fractures compared to radiography. Computed tomography provided an accuracy of close to 100% in persons trained in evaluating CT images.

Trans-iliac pin/bolt/screw internal fixation for sacroiliac luxation or separation in cats: six cases

Trans-iliac pin, bolt or screw stabilisation was performed on six cats with sacroiliac (SI) luxation and separation. For the purpose of this study, SI luxation is defined as the separation of the iliac wing from the sacrum without fracture of the sacral or iliac wing; SI separation is defined as the separation of the iliac wing from the sacrum secondary to fracture of the sacrum and/or the iliac wing. Complications, surgical time and medium-to-long-term outcome were assessed by a retrospective review of the clinical records and owner questionnaires. Postoperative reduction of the SI joint was good-to-excellent in all cases and the outcome was considered good-excellent in all cats apart from one, where the trans-iliac bolt migrated dorsally from the iliac wing. This cat had bilateral SI luxations. Based on our results, trans-iliac fixation of SI luxation/separation is associated with good clinical outcome and should be considered as a treatment option in unilateral SI luxation in cats. Caution should be exercised in the use of trans-iliac pin/bolt as the sole method of stabilisation in bilateral SI luxations.

Hips, elbows and Stifles

Practical relevance Cats commonly present with joint disease and trauma. A methodical approach to diagnostics and treatment can aid the clinician in the management of these cases.

Clinical challenges Cats with joint disease may present with a vague history owing to their independent nature, and gait assessment is often challenging when compared with the dog. Knowledge of feline-specific anatomy is important to avoid over- or misinterpretation of physical examination or imaging findings.

Audience This review of feline joint disease focuses on the more common, non-traumatic conditions of the hip, stifle and elbow. It aims to provide first opinion clinicians with a guide to decision making that will assist them in achieving a diagnosis and formulating a management strategy.

Evidence base There is an extensive body of original articles and textbooks in the published literature relating to aspects of feline joint disease. This article combines information from key companion animal and feline-specific references together with the author’s clinical experience to provide a practical overview of joint disease, and highlight important differences between cats and dogs in terms of presentation and treatment.