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.

Short-Term Clinical and Radiographic Outcome after Stabilization of Femoral Capital Physeal Fractures with Cortical Positional Screws in 39 Cats

OBJECTIVE

 The aim of this study was to report the short-term clinical and radiographic outcome for the treatment of femoral capital physeal fractures with cortical positional screws in cats.

STUDY DESIGN

 Medical records and radiographs of cats with femoral capital physeal fractures stabilized with cortical positional screws were retrospectively reviewed. Signalment, bodyweight, femoral head affected, fracture classification, fracture reduction, implants, concurrent orthopaedic injuries, osteoarthritis, femoral neck osteolysis, complications and 6-week follow-up clinical results were recorded. A short- to long-term follow-up was performed by telephone questionnaire with the owners.

RESULTS

 Forty-six fractures in 39 cats met the inclusion criteria. In 45/46 fractures, radiographic signs of bone healing were present and 35/39 cats were assessed as walking normally by a veterinarian at 6-week follow-up. There was a significant increase in radiographic signs of osteoarthritis (p=0.037) and femoral neck osteolysis (p=0.001) on 6-week follow-up radiographs. Pre- and postoperative osteoarthritis and femoral neck osteolysis were not associated with clinical outcome. The mean follow-up period for the telephone questionnaire was 48 months (range, 5-147 months). Seven out of 25 owners reported a gait abnormality in the short- to long-term.

CONCLUSION

 Femoral capital physeal fractures in cats can be treated successfully with the use of cortical positional screws. This technique may be considered as an alternative to other primary fixation techniques and salvage procedures for the treatment of femoral capital physeal injuries in cats. This technique seemed successful in cats with a low-grade preoperative femoral neck osteolysis.

Outcome of coxofemoral luxation treated with closed reduction in 51 cats

OBJECTIVES

The aim of this study was to describe the outcomes and determine the reluxation rate of cats undergoing closed coxofemoral joint reduction, and to investigate potential risk factors for reluxation of the affected coxofemoral joint.

METHODS

Case information was obtained from electronic medical records from Ocean State Veterinary Specialists and Bay State Veterinary Emergency and Specialty Services between January 2008 and May 2020. Data obtained from 51 cats with coxofemoral joint luxations included patient signalment, direction of coxofemoral joint luxation, concurrent injuries, ease of reduction, time of injury to closed reduction, bandage application and outcome. Data were analyzed for association with outcomes.

RESULTS

Closed reduction of coxofemoral joint luxation in cats had a 51% success rate. The only risk factor demonstrating a statistically significant benefit to the success of closed coxofemoral joint reduction was the application of a bandage (P = 0.02).

CONCLUSIONS AND RELEVANCE

It may be worth attempting closed coxofemoral joint reduction in cats prior to recommending surgery. Placing a bandage (Ehmer or hobbles) after closed reduction may decrease the risk of the coxofemoral joint reluxating, but more studies are needed to evaluate this further. The outcome after closed reduction management for coxofemoral joint luxation in cats is similar to the previously reported success rate in dogs.

Long-term follow up of 44 cats undergoing total hip replacement: Cases from a feline hip registry (2010-2020)

OBJECTIVE

To report indications, complications, and long-term outcomes following feline total hip replacement (THR) using a client-based clinical metrology questionnaire, the Feline Musculoskeletal Pain Index (FMPI), and owner satisfaction.

STUDY DESIGN

Multi-institutional retrospective cohort study.

ANIMALS

Cats (n = 44) that underwent THR (n = 56).

METHODS

Feline THRs submitted to a registry over a 10-year period were reviewed. The FMPI and owner satisfaction surveys were used to assess outcome.

RESULTS

Forty-four cats met the inclusion criteria. Median age was 2 years (range: 0.9-11), and median bodyweight 5 kg (range: 3.3-7.6). British Shorthair and Domestic Shorthair were the most frequent breeds. Most cats were neutered males (33/44) and slipped capital femoral epiphysis (SCFE) was the most common surgical indication (34/56). All implants were cemented micro and nano hip implants. Overall complications (11/56) included 9 major complications. The median duration of follow up was 752 days (range: 102-3089). No association was found between clinical variables and complications. The FMPI score improved from 0.111 (range: 0-1.222) to 2.111 (range: 0.888-3.666) postoperatively (P < .001). Owner satisfaction was reported as "very good" in 30/33 cases (90.9%).

CONCLUSION

A validated client metrology questionnaire showed clinical improvement in cats following THR. The most common indication for THR in cats was SCFE occurring in young male neutered cats. Complication rates were comparable to previous reports.

CLINICAL SIGNIFICANCE

Total hip replacement appears to be a successful surgical treatment for feline hip disease with very good owner satisfaction and acceptable complication rates.

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.

Measurement of ground reaction forces in cats 1 year after femoral head and neck ostectomy

OBJECTIVES

The objective of this study was to compare ground reaction forces (GRFs) of a group of cats after femoral head and neck ostectomy (FHO) with those of a historical control group.

METHODS

We searched the database of the Small Animal Clinic of the Veterinary University in Vienna for cats that had undergone unilateral FHO at least 1 year previously. Owners were telephoned and invited to the clinic with their cats for a re-examination. An in-house owner questionnaire-based evaluation, complete orthopaedic examination, hip radiography and gait analysis with a pressure-sensitive plate were performed, and results were compared within and between groups (FHO group and control group [CG]).

RESULTS

Seventeen cats that had undergone FHO (FHO group) at least 1 year previously and 15 healthy cats (CG) from a previous study were included. Measured GRFs (peak vertical force and vertical impulse [IFz] normalised to total force [%TF]) of the FHO legs were lower than those of the other legs of the FHO group and the legs of the CG. Results of the owner questionnaire were generally good and did not match the results of the GRF comparison. Furthermore, the gaits evaluated during the orthopaedic examination did not correlate with the measured GRFs where we identified a certain degree of lameness (reduced IFz, %TF) in all cats. Cats with limb shortening (dorsally displaced major trochanter major) were not revealed to have different GRF measurements.

CONCLUSIONS AND RELEVANCE

This is the first study to assess GRFs in a large group of cats that had undergone FHO, comparing findings with those in healthy cats. Even if the differences are statistically significant, but rather small, our findings point to a long-term residual gait abnormality that could be detected using a pressure-sensitive plate but not always with an orthopaedic examination, in cats 1 year after FHO.

Complications and outcomes of cats with coxofemoral luxation treated with hip toggle stabilization using ultrahigh-molecular-weight-polyethylene or nylon (2009-2018): 48 cats

OBJECTIVE

To report overall rate and type of complications and outcomes of cats with coxofemoral luxation managed with hip toggle stabilization (HTS), to compare rate of postoperative complications and outcomes of cats treated with ultrahigh-molecular-weight-polyethylene (UHMWPE) or nylon, and to identify risk factors for reluxation and non-excellent outcomes.

STUDY DESIGN

Multi-institutional retrospective cohort study.

SAMPLE POPULATION

Forty-eight client-owned cats.

METHODS

Medical records of cats that underwent HTS from 2008-2018 using UHMWPE or nylon were reviewed. Univariable and multivariable logistic regression was performed to assess for factors associated with reluxation and non-excellent outcome. Final outcome was obtained from owner questionnaire.

RESULTS

Intraoperative and postoperative complications were recorded in two (4.2%) and 11 (24.4%) cats, respectively. The most common postoperative complication was reluxation (n = 5 [11.1%]). Outcome was classified as excellent in 81.1% and good in 16.2% of cats after a median of 445.5 days (range, 53-3720). No difference in rate of complications or outcomes was identified between UHMWPE and nylon. Performance of additional orthopedic procedures, occurrence of intraoperative complications, and non-performance of capsulorrhaphy were associated with reluxation. Performance of additional non-hip procedures (orthopedic/nonorthopedic) was associated with non-excellent outcome.

CONCLUSION

Hip toggle stabilization was associated with a low rate of intraoperative complications and reluxation and excellent long-term outcomes in most cats. No difference in rate of postoperative complications or outcomes of cats treated using UHMWPE or nylon was identified. Cats that underwent additional orthopedic procedures had greater risk of reluxation.

CLINICAL SIGNIFICANCE

Hip toggle stabilization is an effective technique for management of coxofemoral luxation in cats. Comparable results are expected using UHMWPE or nylon.

Traumatic joint luxations in cats: Reduce, repair, replace, remove

PRACTICAL RELEVANCE

Traumatic joint luxations are usually associated with significant trauma and there may be concomitant systemic injury. Joints are unstable as a result of injury to one or more supporting structures and the clinician should aim to determine which structures are damaged with physical examination, diagnostic imaging and careful assessment under sedation/anaesthesia. The aim is to reduce the joint back to its anatomical position, and then to maintain this through repair of damaged structures. However, where this is not possible, replacement or removal (arthrodesis/excision arthroplasty) of the joint remain viable options.

CLINICAL CHALLENGES

Owing to the small size of feline joints and the severity of damage often seen, surgical management of these cases can be challenging. The first priority is to ensure the patient is systemically well before embarking on any specific surgical treatment of a luxated joint. Cats also present challenges in the postoperative period and a lack of patient and owner compliance can be detrimental to postoperative outcomes.

AIMS

This article aims to help the reader diagnose joint luxations and to assist decision-making with an overview of the management and treatment options available.

EVIDENCE BASE

There are a number of original articles and textbook chapters in the literature covering aspects of different joint luxations, particularly for the more common luxations. This article draws on information from key feline research and, where necessary, extrapolates from relevant canine research. The authors also offer practical guidance based on their own clinical experience.

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.

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.

Multi-centre retrospective study of the long-term outcome following suspected traumatic elbow luxation in 32 cats

OBJECTIVES

To describe reduction techniques and clinical outcome in a series of traumatic elbow luxations in cats.

MATERIALS AND METHODS

Retrospective review of unilateral elbow luxations treated at five specialist referral centres. Data included signalment, aetiology, concurrent injuries, luxation direction, time to reduction, primary reduction technique, surgical procedure and complications. Cases were excluded if reduction technique was unknown. Telephone owner questionnaire follow-up was completed using a Feline Musculoskeletal Pain Index.

RESULTS

Thirty-two cats were included. Lateral luxations were most common (n = 21). Time (hours) until attempted initial closed reduction was <24 (n = 12), 24-48 (n = 13), >48 (n = 3) or unrecorded (n = 4). Luxation was treated by closed reduction alone (n = 7) or by surgery (n = 25); 14 of 25 cases underwent primary surgical reduction and 11 of 25 were secondary procedures following failure of closed reduction. Transcondylar bone tunnels and circumferential suture (n = 19) was the most commonly used surgical technique. Catastrophic (n = 1), major (n = 11) and minor complications (n = 5) were recorded; reluxation occurred more frequently after closed reduction (n = 8) than after open reduction with fixation (n = 0). Feline Musculoskeletal Pain Index data were available for 12 cats; outcome was good-excellent in all 12, with a median function score of 64.5/68 (range: 55-68) and a median pain score of 0/15 (range: 0-5). Outcome was not associated with reduction technique.

CLINICAL SIGNIFICANCE

Elbow reluxation occurred in 61% of cats following primary closed reduction but did not occur in any open reduction cases. Reluxation rate increased with duration from injury. Most cats had good-excellent owner-assessed outcome, regardless of reduction technique.

Coxofemoral luxation in pet rabbits: nine cases

Of the pet rabbits presented at one private practice between August 2011 and August 2016 (n=1369), 5·6% presented with a traumatic orthopaedic injury. Of these, 7·8% (n=6) presented with traumatic coxofemoral luxation, the most frequently observed type of luxation. Three cases of non-traumatic coxofemoral luxation in pet rabbits are also discussed. Eight rabbits presented with craniodorsal luxation and one with caudoventral luxation. Five rabbits were initially treated using closed reduction and an Ehmer sling under sedation. Two rabbits responded satisfactorily to closed reduction; their bandages remained in place for 10 and 14 days, and movement was cage-limited for 1 month after bandage placement. The bandage did not prevent re-luxation in three cases. Therefore, two rabbits received iliofemoral nylon sutures, and three rabbits received a femoral neck and head ostectomy. One rabbit was treated directly using open reduction and an iliofemoral nylon suture due to fractures in the same limb. One rabbit was presented in shock, coxofemoral luxation was noticed as an incidental finding and euthanasia was elected by the owner. In conclusion, of the three rabbits treated via femoral neck and head ostectomy one rabbit had an unsatisfactory outcome and two rabbits have non-assessable outcomes. The three rabbits treated with iliofemoral sutures showed satisfactory long-term outcomes and the two rabbits treated with closed reduction and an Ehmer sling showed satisfactory medium and long-term outcomes.