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 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.
Follow-up Care for Cats with Femoral Fractures
After surgery and discharge from the hospital, the cat must be restricted from activity to allow the fracture to heal properly. Activity must be restricted for several weeks after surgery; the duration will vary depending on the severity of the injury, the type of fixation that was used, and the age of the animal. Restricted activity means that the animal should be kept confined to a carrier, crate or small room whenever he cannot be supervised. He cannot play or rough-house, even if he appears to be feeling well; the use of stairs should be limited; and outdoor walks should be just long enough for him to relieve himself and then return indoors for more rest.
Animals whose fracture was repaired with an external fixation device will have pins exiting the skin. The “pin tracts” should be monitored daily for excessive swelling or discharge. Some discharge is normal and any crusty build-up that occurs at these sites can be gently cleaned with warm water.
Analgesics (pain medications) or anti-inflammatory medication should be given as directed by the veterinarian. Analgesics, such as butorphanol (Torbugesic®) can cause sedation, and anti-inflammatory drugs, such as aspirin or carprofen (Rimadyl®), can cause an upset stomach. Your veterinarian should be informed if any adverse side effects occur.
The skin incision needs to be monitored daily for signs of excessive swelling or discharge. These can indicate problems with the incision or possible infection. Contact your veterinarian if these occur.
If at any point your cat stops using the leg again after some improvement following surgery, there could be a problem. Again, call your veterinarian.
Several weeks after surgery, the femur will need to be X-rayed again to make sure the bone is healing properly. If the healing has occurred as expected, the external fixator, if present, will be removed and the cat’s activity level will be allowed to increase slowly back up to normal over the next few weeks.
In general, any other implants that were used in the repair will be left in place unless they cause a problem at some point in the future. Potential problems can include migration (movement) or infection of the implant.