THIS ARTICLE FEATURES PHOTOGRAPHS OF ACTUAL SURGERY
Figure 1. Spencer the cat
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.
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.
Figure 3.
Figure 4.
Location of the tibia in dogs and cats.
Figure 2. AP or front to back x-ray of the tibia.
The fracture is circled.
Figure 3. Lateral or side view of the tibia.
The fracture lines are circled.
This particular fracture is categorized or described as follows: (Closed complete long oblique minimally displaced fracture of the tibia)
- 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.
- Long Oblique – meaning the fracture line crosses the bone at an angle of greater than 30°
- 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
- Minimally displaced – meaning the broken pieces are still aligned in their normal position
Figure 5.
Figure 6.
- 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.
- 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.
- 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.
- 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.
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 8.
Photo of dog with an external fixator
on the right hind metatarsus.3
Diagram of a tibial fracture repaired with an intramedullary pin and cerclage wire [2]
Figure 9. X-ray of Spencer’s tibia following placement of an IM pin and cerclage wire.
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.
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.
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.
Figure 10. Spencer having brunch one day post-operatively.
What can you do if you suspect your pet has suffered a fracture?
- Remain calm!
- Remain calm!
- Remain calm!
- Determine which limb is injured.
- Gently exam for wounds. NEVER ASSUME YOUR PET WON’T BITE OR SCRATCH – ESPECIALLY IF IN PAIN.
- Cover any wounds with a clean dressing.
- 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.
- Call your veterinarian and explain the problem – they will be able to give you more detailed instructions.
- Never attempt to set a fracture on your own or attempt to allow a fracture to heal without veterinary treatment.
- Do not administer medications unless directed by your veterinarian. NEVER GIVE YOUR PET TYLENOL (ESPECIALLY CATS) OR IBUPROFEN
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.
References:
- Slatter D, et al. Textbook of Small Animal Surgery. W.B. Saunders Co.
- Fossum WF, et al. Small Animal Surgery. Mosby-Year Book, Inc.
- Degner DA. Orthopedic Articles. Vet Surgery Central, Inc.
Update on Spencer the cat