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CASE
FILE 3 |
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Spencer’s
Broken Leg (Tibial Fracture) |
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Figure 1. Spencer the cat |
Spencer is
a 4 month-old male-neutered tabby cat (fig.1)
that presented for a left hind limb injury that
occurred the previous evening. When Spencer’s
pal Austin awoke that morning Spencer wasn’t
using the left hind limb and wasn’t his purring
curious self. Austin alerted his mother, and
she rounded up Spencer and family loaded up
the car and headed to the vet.
Upon arrival at AVA Spencer was completely non-weight
bearing on the left hind limb. Spencer was very
vocal and visibly upset with our attempts to
examine him. Even with minimal examination it
was obvious that Spencer was in pain and needed
help.
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| Due
to the amount of pain and anxiety Spencer was
experiencing it was decided sedation would be
necessary to continue the examination.
While under sedation (with a much more comfortable
Spencer) radiographs of the left hind limb were
taken to determine the extent of the injury.
The radiographs (fig.2 & 3) revealed a fracture of the tibia.
Fig. 2 is an x-ray taken from the front of the
bone and shows the tibia with a complete oblique
fracture. Fig. 3 is a lateral or side view of
the tibia that shows the fracture with the upper
and lower limits of the break. For our human
readers, the tibia (fig.4)
is the same bone as your shin bone. |
Figure 2. AP or front to back
x-ray of the tibia. The fracture is circled.
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Figure 3.
Lateral or side view of the tibia.
The fracture lines are circled.
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| This particular fracture
is categorized or described as follows: (Closed
complete long oblique minimally displaced fracture
of the tibia) |
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Closed – meaning the
skin was intact, open fractures are those
where the bone is protruding from the skin
and is exposed to the environment. Although
it didn’t happen in this case the tibia
is a common site of open fractures. Tibial
fractures become open because the medial
or inner aspect of the bone has very little
soft tissue covering the bone thereby making
it easy for the sharp ends of the broken
bone to penetrate the skin. Infection is
presumed with these types of fractures and
the prognosis for rapid complete resolution
is decreased.
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Long Oblique – meaning
the fracture line crosses the bone at an
angle of greater than 30°
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Complete – meaning the
fracture line crosses the entire bone forming
two larger fragments, incomplete would be
a fracture that only crosses one side of
the bone
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Minimally displaced –
meaning the broken pieces are still aligned
in their normal position
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Figure 4. Location of the tibia
in dogs and cats.
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| All of
these aspects of the fracture dictate what type
of repair is best. In this particular fracture
possible treatments could have included: |
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Cast – because the fracture
was not significantly displaced, not open
and infected, and the animal was young and
rapidly growing. Also of note is the fact
that the fibula (small bone adjacent to
the tibia) was still intact making the fracture
treatable with a cast, although it was this
vet’s opinion that treating this fracture
with only a cast is less than ideal treatment
– due to Spencer’s rambunctious disposition.
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Plate and screws – (fig.5)
bone plates are an acceptable means to fix
this fracture, the plate and screws are
placed on the bone and secure the broken
pieces, this type of fixation usually provides
a solid construction, yet I felt in this
situation that a bone plate was somewhat
bulky and was more hardware than needed.
Insertion of a bone plate would have also
required much more dissection and disruption
of the fracture and surrounding tissues
than necessary.
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External fixation –
(fig.6) also an acceptable means
of treating Spencer’s fracture, with this
particular means of fixation the bar is
exterior to the skin and the rods penetrate
the bone. This is a very good means of fracture
fixation. It requires minimal disruption
of the fracture, skin, and surrounding tissue
allowing the fracture to heal rapidly. However,
I felt this was more than necessary in Spencer’s
case and it may have been difficult to find
adequate room to place the lower pins.
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Intramedullary pinning
–(fig.7) IM
pins are inserted into the medullary cavity
of the bone and seated in the dense bone
at the ends of the bone. IM pinning allows
for minimal manipulation of the fracture
and provides a strong rigid construction
when coupled with cerclage wire. This was
the fixation method chosen for Spencer.
Minimal implants were used along with very
minimal disruption of the fracture, and
no unnecessary hardware would be exposed
to hinder Spencer’s movements.
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Figure
5.
Tibial fracture repaired with a bone
plate and screws.1
Figure 6.
Diagram of a tibial fracture repaired
with an external fixation device.1
Figure 7.
Diagram of a tibial fracture repaired
with an intramedullary pin and cerclage
wire.2 |
Figure 8. Photo of dog
with an external fixator
on the right hind metatarsus.3
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Once the fracture was diagnosed
Spencer was given pain medications and a bandage
splint was applied to the broken limb. The treatment
options were discussed with his family. After
reviewing all possible treatments Spencer’s
family decided surgery was the best option and
had the best chance of helping Spencer get back
to normal. Although, we chose IM pinning for
treatment, Austin and his younger brothers no
doubt thought that external fixation would have
been really cool. Spencer would have looked
like part cat and part machine or robot maybe
– that would have been cool to see (fig. 8). |
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Figure 9. X-ray of Spencer’s
tibia following placement of an IM pin and cerclage
wire.
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Spencer was scheduled
for surgery the following morning. A pre-operative
x-ray was taken just prior to surgery to ensure
that no change in the fracture had occurred
over night. A skin incision was created at the
top of tibia to allow for the insertion of the
intramedullary pin. The pin was then inserted
into the marrow or medullary cavity of the bone
and stopped just above the fracture site. Another
small incision was then made on the inside aspect
of the limb (this area of the tibia has very
little tissue covering making it easier to gain
access to the fractured bone) so a surgical
wire could be passed around the fractured bone.
Then the pin was inserted past the fracture
area and seated firmly in the bottom or distal
aspect of the tibia. Intra-operative and post-operative
x-rays were taken to ensure proper placement
and correct alignment of the pin and bone.
Fig. 9 is Spencer’s
tibia following reduction and fixation. The
intramedullary pin is the rod in the center
of the bone and the cerclage wire encircles
the bone at mid-fracture to compress the broken
pieces of bone. |
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A compressive bandage was
applied post-operatively to minimize swelling
and allow for support. Spencer was administered
pain medications, antibiotics, and fluids for
36 hours post-operatively. The day following
surgery Spencer was back to his curious and
purring self (fig.10). The limb felt well enough
to walk on and his appetite had returned with
a vengeance. Spencer was doing well enough to
go home the day after surgery.
Fractures are common orthopedic
injuries of dogs and cats. Fractures can be
caused by a variety of means such as direct
trauma (car accident), indirect trauma, diseases
(tumors or nutritional disorders), or repeated
stress. There are as many different ways to
treat fractures as there are different configurations
and causes of fractures. However, not all fractures
are amenable to every treatment method and only
the veterinarian with the case in front of them
can make the decision as to which treatment
method is most efficacious. |
Figure 10. Spencer having brunch
one day
post-operatively.
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As a pet owner you should
be aware that fractures can occur at any life
stage and in most any setting. Any lameness,
limp, or painful limb in your pet should be
brought to the attention of your veterinarian.
Non-displaced and incomplete fractures can progress
to complete, open, or comminuted fractures if
not treated early.
| What can you do if you suspect
your pet has suffered a fracture? |
| 1. |
Remain calm! |
| 2. |
Remain calm! |
| 3. |
Remain calm! |
| 4. |
Determine which limb is injured. |
| 5. |
Gently exam for wounds. NEVER
ASSUME YOUR PET WON’T BITE OR SCRATCH –
ESPECIALLY IF IN PAIN |
| 6. |
Cover any wounds with a clean
dressing. |
| 7. |
If your dog can’t walk or
is unconscious get help, improvise a stretcher
with a blanket, board, etc. and move to
a safe area |
| 8. |
Call your veterinarian and
explain the problem – they will be able
to give you more detailed instructions |
| 9. |
Never attempt to set a fracture
on your own or attempt to allow a fracture
to heal without veterinary treatment. |
| 10. |
Do not administer medications
unless directed by your veterinarian. NEVER
GIVE YOUR PET TYLENOL (ESPECIALLY CATS)
OR IBUPROFEN |
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Pain medications
are always an important part of treating animals
with fractures, but Tylenol and Ibuprofen can
have serious side effects in animals – THEY
MAY EVEN LEAD TO DEATH. Unless directed by a
veterinarian I don’t recommend medicating fracture
patients prior to examination. Some medications
can cause complications with anesthesia, surgery,
and tissue healing so stay away from medications
unless directed to do so by a veterinarian.
The goal of first aid when
dealing with fractures is always to attempt
to minimize any further damage. Be gentle when
handling the injured limb and animal. Bandaging
when possible (especially if your veterinarian’s
office is a long distance) can help stabilize
the limb, make the animal more comfortable for
transport, and reduce your pet’s level of anxiety.
A soft conforming bandage is best. Splinting
is best left to an expert as improperly placed
rigid splints can further damage the bone and
limb – do not attempt to splint a fracture unless
you have proper training. Always contact your
veterinarian if you are unsure of the proper
steps to take in order to transport your pet
safely. |
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The take home
message in this segment is to understand that
most fractures in animals are completely treatable.
If you remain calm, contact your veterinarian
with any suspected fractures, and obtain treatment
early the vast majority of fractures are 100%
treatable. Most pets with broken bones will
return to complete soundness with a very good
prognosis if treated. Also, one should understand
that there are many different means of fracture
treatment and fixation. Every case is different
and one method of treatment/fixation is not
applicable to every fracture.
We would like to thank Spencer and his pal Austin
for allowing us to present his case. On our
last check Spencer was resting comfortably at
home approximately 5 days after surgery. We
all wish him well and look forward to updating
this page once healing is complete. |
Figure 11. Spencer ready to be
discharged and see his family.
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References:
1. Slatter D, et al. Textbook of Small Animal
Surgery. W.B. Saunders Co.
2. Fossum WF, et al. Small Animal Surgery. Mosby-Year
Book, Inc.
3. Degner DA. Orthopedic Articles. Vet Surgery
Central, Inc. |
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| [CASE FILE 3.1] Update on Spencer the cat is now available |
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