Section: Veterinary Care In-depth
Diagnosis In-depth
A thorough physical examination is important to make sure your pet is not showing signs of hypovolemic shock secondary to the trauma or blood loss. It is also important to make certain that there are no other injuries present. Additional tests may include:
Chest X-rays (thoracic radiographs). Chest trauma, in the form of pulmonary contusions (bruising) or pneumothorax (collapsed lung secondary to free air within the chest cavity), must be ruled out with chest radiographs prior to anesthesia to repair the leg fracture.
Complete orthopedic examination. A complete orthopedic examination must be performed to look for the cause of the non-weight bearing lameness as well as possible injuries in other bones or joints. Examination involves palpation of all of the bones and joints of each leg for signs of pain or abnormal motion within a bone or joint as well as an assessment of the neurological status of each leg. The thorough orthopedic examination is especially important for an animal that is unable or unwilling to get up and move on the other three legs. Specific palpation of the thigh finding swelling, bruising, and crepitation (abnormal "crunchy" feeling with motion) can be highly suggestive of fracture of the femur.
Radiographs of the leg. Two radiographic views of the cat's thigh are used to confirm the diagnosis of femoral fracture and may also show pelvic fractures or hip dislocation if they are present. Based on the location and severity of the fracture, a more informed discussion with the owner can occur regarding potential treatments, prognosis and costs.
No laboratory tests are required to make the diagnosis.
Treatment In-depth
Treatment will vary depending on the severity of the injuries and may include:
Emergency care for concurrent problems. Shock is a frequent result of major trauma and must be treated quickly. Treatment for shock involves intravenous fluid administration to maintain blood pressure and adequate oxygen delivery to the body. Injury to the lungs and chest cavity are also commonly seen after major trauma and may require supplemental oxygenation or removal of free air (pneumothorax) from around the lungs.
Soft-tissue injuries must be addressed in order to minimize the chance for the development of wound infections. Lacerations and other open wounds or open fractures must be cleaned of debris and covered or closed to minimize infections.
In the interim between treating the emergency patient and surgical repair of the femoral fracture, all of the orthopedic injuries that have been found should be addressed with splints and/or pain medications to keep the animal comfortable until the fracture can be treated.
Depending on the specific fracture type, location, and age of the animal, femoral fractures may be repaired in many different ways. Pins alone, pins and wires, bone plates and screws, and external fixators (pins holding the bone fragments stable through holes in the skin, like a scaffolding) are used separately or in combinations to provide stability to the bone fragments while they heal.
Femoral fractures are not adequately stabilized with a cast or splint.
Femoral fractures, as well as any other traumatic injuries that the animal might have, are painful and the animal will be given analgesics before and after surgery.
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