Section: Veterinary Care In-depth
Diagnosis
A thorough physical examination is very 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:
Thoracic radiographs (Chest X-rays). Chest trauma, in the form of pulmonary contusions (bruising) or pneumothorax (collapsed lung lobes secondary to free air within the chest cavity), must be ruled-out with chest radiographs prior to anesthesia to repair the leg.
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 foot and finding swelling, bruising, pain, and crepitation (abnormal "crunchy" feeling with motion) can be highly suggestive of fractures of the metatarsal or metacarpal bones.
Radiographs of the foot. Two radiographic view of the animal's foot are used to confirm the diagnosis of metatarsal or metacarpal fractures. 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
Emergency care for concurrent problems is paramount. 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. Once stabilized, additional treatment may include:
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 stabilization of the metatarsal or metacarpal fractures, all of the orthopedic injuries that have been found should be addressed with splints and/or pain medications to keep the animal comfortable.
Depending on which bones are fractured, how many bones are fractured, and the age of the animal, metatarsal and metacarpal fractures may be repaired in a few different ways. If at least one of the weight bearing bones is not fractured, the foot may be treated without surgery by immobilizing the foot in a cast or splint. The remaining unbroken bones act as internal "splints" that help to maintain alignment of the fractured bones. For those fractures that involve both of the weight bearing bones and especially those that involve all four bones in the foot, surgical stabilization will likely be recommended. Depending on the size of the animal's bones, pins alone, pins and wires, or bone plates and screws can be used to provide stability to the bone fragments while they heal. After surgical repair, the foot is usually placed in a splint to protect the small implants while the bones regain strength.
Fractures of these bones in the feet, as well as any other traumatic injuries that the animal might have, are painful and the cat will be given analgesics before and after surgery.
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