Treatment of Fractures of the Sacrum and Sacrococcygeal Region

A technique of sacral nerve decompression for sacrococcygeal fractures on luxations is presented. Anatomic and neurologic considerations are discussed forthe dog and thecat. This procedure was used ineleven clinical cases, with six animals showing complete fecal and urinary continence. Three of the remaining cases made incomplete recoveries but were manageable at home.     

Tension band stabilization of fractures and luxations of the thoracolumbar vertebrae in dogs and cats: 38 cases (1993-2002)

OBJECTIVE: To determine the outcome of dogs and cats in which a tension band technique was used to stabilize traumatic fractures and luxations of the thoracolumbar vertebrae. DESIGN: Retrospective study. ANIMALS: 38 client-owned animals (22 dogs and 16 cats) weighing between 1.4 and 45 kg (3 and 99 lb). PROCEDURE: Medical records of cats and dogs that underwent tension band stabilization of thoracolumbar fractures and luxations at the University of Zurich between 1993 and 2002 were reviewed. The stabilization technique was a modification of a spinal stapling technique with a figure 8 hemicerclage wire placed in a tension band fashion across the lesion. Neurologic status, lesion location and type, and concomitant traumatic injuries were assessed from the medical records and preoperative radiographs. Clinical outcome and complications were determined through follow-up examinations or telephone conversations with the owners. RESULTS: Complete or satisfactory neurologic recovery was achieved in 30 (79%) patients. Seven patients were euthanatized (6 owing to poor neurologic recovery and 1 owing to implant failure), and 1 dog was managed at home despite paraplegia. Clinically, only 4 patients (11%) had evidence of implant or fixation failure; all were dogs weighing > 16 kg (35 lb). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that the tension band technique may be appropriate for stabilization of fractures and luxations of the thoracolumbar vertebrae in cats and small- or medium-sized dogs. In larger dogs, fixation strength may be insufficient to stabilize certain fracture types and ancillary external or internal fixation methods may be needed.     

Treatment of spinal fractures using Lubra plates. A retrospective clinical and radiological evaluation of 15 cases

The purpose of this retrospective study was to review the clinical use along with the short- and long-term outcome in patients treated with Lubra plates to stabilize spinal fracture and dislocations that were considered unstable at time of surgery according to the 'three compartment theory'. The data that were collected included breed, age, gender, body weight of the patients, cause of injury, neurological grade (pre- and postoperative), radiographic findings, surgical treatment, and clinical and radiological outcome. Thirteen dogs and two cats were included with thoracic (1 case), thoracolumbar (3 cases), midlumbar (5 cases) and caudal lumbar (6 cases) vertebral fractures. For stabilization, the small-sized (3 cases), medium-sized (6 cases), and large-sized (6 cases) Lubra plates were used. The clinical outcome was excellent in 10/15 patients, functional in 2/15 and poor in 3/15 with a median follow-up period of nine years (range 2 months to 12 years). The fractures eventually stabilized by ventral spondylosis. No implant failure was seen, however demineralization of the spinous processes necessitated implant removal in one case. Our results suggest that Lubra plating is an appropriate technique for thoracolumbar and lumbar vertebral fractures as well as luxations in dogs and cats. The prognosis for neurological recovery was excellent when the animal had a neurological grade of 3 and was not paralyzed.     

Somatosensory-evoked and spinal cord-evoked potentials in response to pudendal and tibial nerve stimulation in cats

Somatosensory-evoked potentials (SEP) and spinal cord-evoked potentials (SCEP) were recorded in clinically normal adult cats in response to electrical stimulation of pudendal and tibial nerves to provide normative data that can be used in a clinical evaluation of pudendal nerve function in cats after sacral or sacrococcygeal luxations or fractures. Responses to tibial nerve stimulation were included in the study as an internal control because it is usually not involved in these types of injuries and because its SEP and SCEP are easily recorded. Evoked potentials were characterized by the latencies (ms) of positive (P or p) and negative (N or n) peaks. The SEP resulting from percutaneous pudendal nerve stimulation consisted of a prominent P-N-P potential in the 30- to 80-ms range. The pudendal SCEP was not successfully recorded because of large muscle artifacts evoked from the sacral area. The tibial SEP was similar to the pudendal SEP, except that the prominent P-N-P series in the 35- to 81-ms range was preceded by a smaller p-n-p-n sequence in the 7- to 23-ms range. The tibial SCEP consisted of a P-N-P series in the 2- to 4-ms range.     

Fractures and luxations of the vertebral column.

External fixation of the vertebral column is indicated to treat fractures of the caudal lumbar spine, open fractures where vertebral osteomyelitis is present or likely to occur, and vertebral fractures not easily stabilized by internal fixation alone (e.g., compression fractures, fractures including spinous processes, and articular facets). Advantages of external fixation of caudal lumbar fractures, especially in combination with dorsal fixation devices, include the following: Fracture fixation does not preclude dorsal decompression; fixation devices need not be applied directly to the fractured vertebrae; and the combined technique provides dorsal and ventral vertebral fixation, which is more stable than dorsal fixation alone. Although external fixation is not applicable to all vertebral fracture/luxations in small animals, it provides additional points of fixation for rigid stability. Animals with vertebral fracture/luxations treated with an external fixation device have tolerated the external portion well. Development of additional applications for this method of vertebral fracture repair seems warranted.     

Sacral fractures in dogs and cats: a classification scheme and review of 51 cases

classification scheme for sacral fractures was based on a review of sacral fractures in 34 dogs and 17 cats. They were classified into five categories based on their radiographic appearance on standard lateral and ventrodorsal radiographs of the pelvis. Concomitant pelvic injuries were commonly observed: 32 per cent of dogs had a fracture of an ilium and 65 per cent of cats had unior bilateral sacroiliac subluxation. Neurological deficits were common where the fractures traversed the spinal canal or sacral foraminae. Comparison is made between sacral fractures in dogs and cats, and humans.     

Management of vertebral column fractures in dogs and cats: 211 cases (1977-1985)

Hospital records and radiographs of 211 dogs and cats with vertebral column fractures or luxations evaluated at the University of Tennessee Veterinary Teaching Hospital between April 1977 and September 1985 were reviewed. After neurologic examination, status of the animal was graded on a scale of 1 to 8. Decision to treat each animal either medically or surgically was based on the extent and type of injury, neurologic signs, veterinarian's experience, and owner's wishes. After treatment, neurologic status was evaluated on the aforementioned scale and differences in the outcome of treatment were determined between surgically and medically treated groups, relative to initial neurologic status and location of the fracture. Surgically treated animals had pretreatment mean (+/- SD) neurologic status (3.71 +/- 1.35) that was slightly worse (P = 0.0079) than that of medically managed cases (5.16 +/- 1.48). Animals of the surgically treated group improved significantly (P = 0.0122) more than did those of the medically treated group but after treatment, significant differences in neurologic status were not evident between surgically (6.67 +/- 1.49) and medically (7.07 +/- 1.24) treated animals. Medically treated animals required substantially longer to reach optimal neurologic status, but the average hospital stay was nearly twice as long for the surgically treated animals (13.5 days), compared with those treated medically (7.1 days). Animals with thoracic vertebral fractures had mean neurologic status that was worse than that in animals with cervical vertebral fractures (P = 0.0109). After either medical or surgical treatment, neurologic status did not differ among animals with cervical, thoracic, or lumbar vertebral fractures.(ABSTRACT TRUNCATED AT 250 WORDS)     

Fractures of the Humerus in Dogs and Cats A Retrospective Study of 130 Cases

Case histories of 130 dogs and cats with humeral fractures were reviewed. The different types of fractures were classified. Most animals with proximal, shaft, and supracondylar fractures had excellent results. The poor prognosis associated with distal articular fractures was due most often to failure of the fixation device in the supracondylar area; best results were achieved with a plate on the caudal and medial surface of the distal humerus.     

A retrospective clinical study of the fractures and luxations of the mandible in the cat

Twenty-six cases of mandibular fractures and luxations are reviewed. Mandibular trauma was due to car accidents (46%) and falls from great heights (23%). Cardiovascular shocks (40%), thoracic injuries (23%), epistaxis (30%), cleft palates (19%), subconjunctival hemorrhages (15%), broken canines (15%), concussions (15%), maxillary fractures (12%) were the most frequently encountered associated problems. Of the 26 cats, 22 had symphyseal fractures, 6 mandibular body fractures, 4 ramus fractures (3 of which were articular) and 6 had temporo-mandibular luxations. Open reduction and internal fixation was performed in 21 cases, surgery being indicated for unstable symphyseal and body fractures, the rostral body fractures being the most challenging to repair. Conservative therapy and ancillary treatment methods such as external coaptation and pharyngostomy were used for the fractures of the ramus. Six temporo-mandibular luxations associated with mandibular fractures in 5 cases were reduced under anesthesia. Good dental occlusion and mandibular function was obtained in the 24 treated cases.     

Temporomandibular joint injuries and ankylosis in the cat

Objective: To evaluate cause, location, treatment, and the clinical outcome of traumatic temporomandibular joint (TMJ) lesions and TMJ ankylosis in cats. Methods: Cats with TMJ injuries were included in this study. Lesions were classified as luxations, fractures of the condylar process, and intra-articular temporal bone fractures. Signalment, cause and type of injuries, treatment methods, clinical outcome, complications and joint ankylosis were assessed and evaluated statistically. Results: Temporomandibular joint lesions were observed in 82 of 161 cats with maxillofacial injuries. One hundred forty-nine TMJ lesions were determined in 112 joints. Falling was the most common cause and fractures of the condylar process were the most common types of injuries. Isolated TMJ injuries and caudal TMJ luxations were mainly caused by falling. Condylectomy was used in ankylosis, chronic luxation, reluxation and in two cases with multiple TMJ lesions. Ankylosis was observed in 10.97% of cases and was generally observed in fracture combinations of condylar process and mandibular fossa (χ2 = 8.52; p <0.05). No significant relationship between age and development of ankylosis (χ2 = 3.995; p >0.05) was found. Conclusion: In contrast to previous studies, traumatic TMJ lesions were observed in a considerable amount of cats with maxillofacial injuries, and fractures of the condylar process were the most common type. Lesions caused by falling were mostly simple, whereas vehicular trauma caused more complicated lesions. Ankylosis did not appear as a rare condition. Any cat with TMJ injury is susceptible to the development of ankylosis.     

Stabilization of Sacroiliac Luxation in 40 Cats Using Screws Inserted in Lag Fashion

Objective: To (1) identify prognostic indicators for stability after stabilization of sacroiliac luxation with screws inserted in lag fashion and (2) report dorsoventral dimensions of the sacrum in cats. Study Design: Multicenter retrospective study. Sample Population: Cats (n=40) with sacroiliac luxation. Methods: Case records and radiographs of cats presented at the Queen's Veterinary School Hospital Cambridge and the Royal Veterinary College Hatfield for screw fixation of sacroiliac luxation were reviewed. Dorsoventral dimensions of 15 feline cadaveric sacral bodies were measured to identify the appropriate implant size for use in fixation with screws inserted in lag fashion. Results: Of 40 cats, 13 had left, 14 right, and 13 bilateral sacroiliac luxations. Of 48 screws analyzed, 42 (87.5%) were placed within the sacral body or exited ventrally and 6 (12.5%) were considered malpositioned. Screw purchase within the sacrum was statistically different between unstable and stable repairs (P=.001). Using confidence intervals for screw length within the sacrum and effect on stability, the lowest screw depth that contained 95% of the screws that did not loosen was ∼60% of the sacral width. Mean dorsoventral sacral dimension at its narrowest point was 5.9±1.14 mm. There was no significant difference in the incidence of implant loosening between those luxations that were 100% reduced and those that were <100% reduced (P=.7837). Conclusions: Screw purchase within the feline sacrum of at least 60% of the sacral width significantly reduces the risk of loosening. Clinical Relevance: Screw placement to a depth of 60% of the width of the feline sacrum is recommended.     

Spinal fracture and luxation in dogs and cats: a retrospective evaluation of 95 cases.

The purpose of this retrospective study was to review cases of spinal fractures or luxations (SFL) treated with various modalities in order to describe fracture location, neurological status, treatment, outcome and complications in a patient population at a single centre. The medical records of dogs and cats that had been diagnosed with a SFL between C1 and L7 between January 1995 and June 2005 were reviewed in order to collect pertinent data. Ninety-five cases were included in this study. The severity of spinal cord injury was graded on a scale from 0 to 5. Vehicular trauma was the most common cause of SFL. Spinal fractures were localized between C1-C5 in 10 cases, C6-T2 in one case, T3-L3 in 54 cases, L4-L7 in 36 cases. Thirty patients that were euthanatized without treatment had a median neurological score of 5. Twenty-eight patients, all of which had motor function, were treated conservatively and there was not any change in their median neurological grade at the time of discharge. Thirty-seven patients had surgery, 27 of which were non ambulatory. Thirty-five of 37 were stabilized using pins and/or screws and PMMA or various other techniques. The median neurological grade of surgically treated patients improved by one point between the time of initial diagnosis and discharge. Implant removal was performed in five cases. The patients that were treated with pins and/or screws and PMMA were significantly more improved than conservatively managed patients at the time of discharge, although the surgically treated patients were hospitalized significantly longer than the conservatively managed patients. Our results suggest that dogs that retain pain sensation prior to surgery have a good prognosis for functional recovery. In this study, the dogs that were treated conservatively retained purposeful movement and had a good prognosis for recovery.     

Treatment of fractures of the mandible and maxilla by mini titanium plate fixation systems in dogs and cats

Mini titanium plates were used to repair certain fractures of the maxilla and mandible in dogs and cats, under general anaesthesia. The location of the fractures treated were: corpus mandible, one dog; corpus mandible and symphysis, two dogs; caudal mandible, two dogs; rostral mandible, one dog; maxilla, one dog; nasal bone, one dog; corpus mandible and symphysis, one cat; caudal mandible, one cat; and maxilla, one cat. The healing periods varied from 6 to 9 weeks. In seven cases, implants were removed after a period of 3.5 to 18 months. In four cases the implants were left in place. The follow up period was between 8 and 36 months. In ten cases the procedure was successful, however in one case the outcome was not satisfactory due to a broken plate. There were no instances of dental malocclusion, nonunion, malunion, osteomyelitis or soft tissue infection. Eating, playing with toys, a fast transition to solid food and a quick return to normal jaw movements were observed. In our hands, the mini titanium plate fixation system was a safe and effective method for repairing certain maxillary and mandibular fractures in dogs and cats.     

High-rise syndrome in cats

High-rise syndrome was diagnosed in 132 cats over a 5-month period. The mean age of the cats was 2.7 years. Ninety percent of the cats had some form of thoracic trauma. Of these, 68% had pulmonary contusions and 63% had pneumothorax. Abnormal respiratory patterns were evident clinically in 55%. Other common clinical findings included facial trauma (57%), limb fractures (39%), shock (24%), traumatic luxations (18%), hard palate fractures (17%), hypothermia (17%), and dental fractures (17%). Emergency (life-sustaining) treatment, primarily because of thoracic trauma and shock, was required in 37% of the cats. Nonemergency treatment was required in an additional 30%. The remaining 30% were observed, but did not require treatment. Ninety percent of the treated cats survived.     

Evaluation of Closed Reduction and Screw Fixation in Lag Fashion of Sacroiliac Fracture‐Luxations

Objective— To evaluate outcome by radiographic assessment after closed reduction and percutaneous screw fixation in lag fashion of sacroiliac fracture‐luxations in dogs. Study Design— Retrospective study. Animals— Dogs (n=24) with sacroiliac fracture‐luxations. Methods— Medical records (1999–2006) and radiographs of 24 dogs (29 fracture‐luxations) that had stabilization of sacroiliac fracture‐luxation by fluoroscopic‐guided closed reduction and percutaneous screw fixation in lag fashion were reviewed. Signalment, body weight, number, and location of all concurrent injuries and implants used for repair were recorded. Radiographs were used to evaluate the accuracy of screw placement in the sacral body, screw depth/sacral width ratio, reduction of the sacroiliac joint, pelvic canal diameter, and hemipelvic canal width. Radiographic re‐examination (range, 4 to >8 weeks postoperatively) was available for evaluation. Results— Mean screw depth/sacral width ratio on immediate postoperative and re‐examination radiographs was 64% and 61%, respectively. Mean percentage reduction of the sacroiliac joint on immediate postoperative and re‐examination radiographs were 91% and 87%, respectively. Pelvic canal diameter ratio demonstrated successful restoration of the pelvic canal. Hemipelvic canal width ratio documented successful closed reduction repair independent of concurrent pelvic injuries. Conclusion— Successful repair of sacroiliac fracture‐luxations, determined by radiographic assessment, can be achieved by fluoroscopic‐guided closed reduction and percutaneous screw fixation in lag fashion. Clinical Relevance— Fluoroscopic‐guided closed reduction and percutaneous screw fixation in lag fashion of sacroiliac fracture‐luxations is a minimally invasive technique that restores and maintains pelvic canal dimensions and should be considered as an alternative to open reduction or nonsurgical management of sacroiliac fracture‐luxations.     

Modified intramedullary pin technique for repair of distal femoral physeal fractures in the dog and cat

A modified intramedullary pin technique for surgical repair of distal femoral physeal fractures in dogs and cats provided stability at the fracture site and allowed early range of motion. The fixation and stability of this technique was compared with that achieved with a multiple pin technique. Fixation failure did not occur in 11 animals treated by the modified intramedullary pin technique, whereas there were 2 failures in 13 patients treated by a multiple pin technique.     

Results of extra-articular stabilisation following open reduction of coxofemoral luxation in dogs and cats

This report describes 14 dogs (mean age six years, mean bodyweight 25 kg) and three cats (mean age 9-3 years, mean bodyweight 6–7 kg) with coxofemoral luxations of one to 91 days duration (median four days). In 47 per cent of the cases concomitant fractures or luxations (including three bilateral luxations) were present. Closed reduction was immediately unsuccessful in five cases and eventually unsuccessful in seven cases, whereas in five cases the nature of the additional trauma required surgical intervention. Via a craniolateral approach to the hip joint, combined with trochanter osteotomy in 24 per cent of the cases, the luxation was reduced and remnants of the capsule were sutured in 82 per cent of the cases. In all cases an extra-articular iliofemoral suture band was applied to limit the range of motion of the femoral head. The technique is described and illustrated in detail. The success rate proved to be strongly related to the suture material and varied from excellent to poor. This extra-articular stabilisation technique had excellent results in acute and chronic coxofemoral luxations in dogs when multifilamentous non-absorbable material was used, even when no additional non-weightbearing sling was used.     

Miniplate Fixation for Repair of Mandibular and Maxillary Fractures in 15 Dogs and 3 Cats

Maxillofacial miniplates and screws were used for skeletal fixation in 15 dogs and 3 cats that sustained a variety of mandibular and maxillary fractures. These implants were used as neutralization or buttress fixation in 11 caudal (junction of the ramus with the mandibular body) and 2 rostral mandibular fractures, 4 maxillary fractures, and 2 zygomatic arch fractures. All but one of the fractures healed with appropriate occlusion and excellent function. In one case of a rostral mandibular fracture, soft tissue dehiscence occurred accompanied by a loss of the fixation and subsequent distraction of the bone fragments; reasonable function was obtained by performing a rostral mandibulectomy. Plate contouring and application of the miniplates along the appropriate biomechanical lines of stress was easily performed and permitted the biomechanical principles of tension band fixation to be applied in most cases. Miniplate fixation, either used alone or in combination with other fracture fixation techniques, achieved sufficiently rigid skeletal fixation to provide uncomplicated healing and good to excellent functional and cosmetic results in 14 dogs and 3 cats.     

Use of a plate-rod construct and principles of biological osteosynthesis for repair of diaphyseal fractures in dogs and cats: 47 cases (1994-2001)

OBJECTIVE: To determine outcome for dogs and cats with diaphyseal fractures in which a plate-rod construct was used for fracture repair. DESIGN: Retrospective study. ANIMALS: 35 dogs and 12 cats. PROCEDURES: Medical records and radiographs were reviewed to obtain information concerning signalment, fracture severity, construct design, time to radiographic union, complications, and outcome. Clients were contacted by telephone to obtain information on complications, limb usage, and overall satisfaction with the procedure. RESULTS: 31 femoral, 9 humeral, and 7 tibial fractures were assessed. Thirteen fractures consisted of 2 fragments, 22 consisted of 3 to 5 fragments, and 12 consisted of > 5 fragments. Forty-six of 47 (98%) fractures reached union. Mean +/- SD times to radiographic union were 7.5 +/- 2.7 weeks for the dogs and 4.8 +/- 1.3 weeks for the cats. There were 4 short-term, minor complications and 15 long-term complications (2 major and 13 minor). Owners of 21 of 30 dogs (70%) and 9 of 12 cats reported that their animals had normal limb function. Twenty-six of 28 dog owners (93%) and 12 of 12 cat owners indicated that they were satisfied with results of the procedure. As surgery time increased, time to union also increased. Time to union for fractures with > 5 fragments was significantly shorter than time to union for fractures with < or = 5 fragments. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that plate-rod constructs can successfully be used for repair of diaphyseal fractures of a wide range of severity in dogs and cats.