Section: Veterinary Care In-depth
Diagnosis
No laboratory tests are required to make the diagnosis, but your veterinarian may recommend the following:
Thorough physical examination. It is very important to make sure your pet is not showing signs of hypovolemic shock, which is shock due to reduced blood volume, secondary to the trauma or blood loss. It is also important to make certain that there are no other injuries present. A digital rectal examination should be performed to make sure that sharp bone fragments within the pelvic canal have not also injured the rectum.
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. The thorough orthopedic examination is especially important for an animal that is unable or unwilling to get up and move. Crepitation, which is the abnormal "crunchy" feeling with motion, and pain during manipulation of the hip joint(s) may be the only abnormal findings. They do not specifically indicate that the pelvis is broken, but they may help to direct the veterinarian to radiograph the pelvis to look for possible injuries in the hips or pelvis.
The neurologic status of each leg must also be assessed before any surgery is considered. The sciatic nerves are extremely important to function of the hind legs and they travel very close to the bone on their way to each leg. They can become damaged during the trauma and may alter the recommendations for treatment if present.
Radiographs (x-ray) of the pelvis. Two radiographic views of the cat's pelvis are used to confirm the diagnosis of pelvic fractures and may also show sacroiliac luxation (dislocation), coxofemoral luxation, or femoral fracture 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.
Treatment In-depth
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 pelvic 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 fractures can be properly addressed.
Depending on the specific fracture type, location, and age of the animal, pelvic fractures may be managed in one of two ways. Some pelvic fractures may not need surgical stabilization. Minimally displaced fractures that do not involve the hip joint might fit into this category. Most other pelvic fractures should be stabilized in order to give the animal the best chance for a successful outcome, with the quickest return to function and the least painful recovery period.
For most situations of pelvic fractures that do not involve the acetabulum, a bone plate and screws are usually used to support the fractured ilium. Fractures of the ischium and pubis are usually not repaired. Fractures that do involve the acetabulum may need to have the acetabulum carefully reconstructed and stabilized or a procedure in which the femoral head and neck are cut off the shaft of the femur might be recommended. This procedure is done in order to minimize the chance for the animal to have long-term problems associated with a hip joint that heals in an abnormal way leading to future arthritis. If a sacroiliac luxation is also present, the luxation may require repair and stabilization as well. When both sides of the pelvis are broken, only one or both sides may require surgical repair.
Pelvic fractures cannot be adequately stabilized with a cast or splint.
Pelvic 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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