General Fracture Information in Cats
General Information About Fracture in Cats
A fracture is a break or crack in a bone. Although we commonly think of fractures as involving a leg, it is also possible to fracture the skull, jaw, spine, ribs, pelvis and digits (fingers) as well as the long bones and small bones of the front and back limbs.
Practically every bone in your cat’s body is susceptible to fracture, and some, like spinal fractures, have a higher priority to treat. The symptoms that arise with fractures are based on the body part injured and any organ damage. Fractures are usually caused by a traumatic event; however, pathologic fractures can occur from relatively low energy events when preexisting disease such as a tumor or a metabolic bone disease like rickets weakens the bone. Some breeds are also susceptible to particular fractures based on their anatomy, conformation and use (such as hunting or racing).
Because of the trauma involved with a fracture, it is imperative that your cat be checked for concurrent or parallel traumatic injuries. Though your cat’s fracture may seem traumatic, rarely is the fracture by itself a cause for urgent surgical treatment. Your pet should first be evaluated for shock, neurological problems and injury to internal organs.
What to Watch For
- Extreme weakness or depression
- Difficulty breathing
- Abdominal discomfort or distention
- A change in mental status
Diagnosis of Feline Fractures
Diagnostic tests that may be needed to recognize and treat fractures include:
- Complete medical history and physical examination
- Radiographs (X-rays) of the affected limb or area
- Chest and abdominal radiographs to rule out obvious organ injury especially for trauma patients
- Blood tests to evaluate for systemic organ trauma and diseases or consequences of shock
Treatment of Feline Fractures
Depending on the physical status of your cat, your veterinarian may temporarily stabilize the fracture by applying a splint, padded bandage or other device. After the patient is stable, definitive fracture repair can be instituted. Your veterinarian may recommend a consultation with an orthopedic specialist.
The type of repair undertaken depends on a number of factors:
- The fracture type and duration
- The fracture location
- The presence of multiple bone fractures
- The intended activity of the patient
- The patient’s age
- The owner’s financial resources and commitment
- The surgeon’s experience
Definitive fracture reduction and stabilization involves either closed reduction, in which a cast or splint is applied without surgery. A surgical method may also be an option using some type of metallic surgical implant such as a pin, wire, plate, screw, nail or fixator. The surgical technique often provides the best repair and chance for full return to function.
Frequently used implants include:
- Pin and wires
- Plates and screws
- Interlocking nails
- External skeletal fixators (ESF)
ESF utilizes fixation pins that are placed through the skin and into the bone fragments. A series of clamps and bars or rings are used to stabilize the major fracture fragments.
Advanced veterinary surgery is technically equivalent to that enjoyed by human patients and uses similarly expensive materials (implants, bone plates, fixator devices) for repair of some fractures. The most desirable treatment can be somewhat costly. If medical and surgical costs are an issue, it is important to discuss the therapy options with your veterinarian first. But remember that if you choose a less desirable option, the success rate may be lower and the chance for return to limb function less than ideal or you may incur repeated visits to the veterinarian for problems associated with the original fracture. These visits can also contribute to overall veterinary costs.
Home Care and Prevention
Carefully follow all the instructions your veterinarian provided and pay particular attention to the wound and the bandages or splints that were applied. Watch for redness, swelling or abnormal discharge from the incision.
All bandages, splints or casts must be kept clean and dry. It is better to have no bandage than a loose or wet one.
Return for reevaluation as recommended by your veterinarian. X-rays may be taken to make sure the fracture is healing properly.
In-Depth Information on Feline Fractures
Fractures are caused by a complex number of forces that exceed the bone’s ability to absorb them. Twisting, shearing, bending, compression and torsion all play a role in the development of a fracture. The type of force applied to a bone during trauma in many respects determines the fracture pattern of the bone. Bones are generally stronger when they are compressed compared to when the force pulls (tension) on the bone.
Fractures can be classified as closed or open. Open fractures occur part of the bone has penetrated through the skin. Large bone pieces sticking through the skin are obvious indicators of an open fracture; however, frequently the bone will penetrate through the skin and then retract, leaving a hole in the skin. Although an open fracture can be dramatic and emotional, the prognosis is often similar to that of a closed fracture where the bone fragments have not penetrated the skin.
If your pet develops a fracture that was the result of a low energy (mild) trauma (such as walking down stairs or running in the yard), your veterinarian will want to determine if a preexisting disease that weakened the bone is present. Examples of such conditions that weaken bone include bone tumors (cancer) or metabolic bone disease. A thorough clinical and radiographic exam is necessary to define preexisting disease.
Because multiple disorders may occur with trauma, a thorough clinical examination is necessary. Cats that have been hit by a car should have a chest X-ray (radiograph) taken to evaluate for concurrent chest trauma.
Some cats may have subtle joint injuries or spinal injuries with their more obvious long bone fracture. It is imperative to evaluate these patients fully.
Diagnostic tests, which may be needed to recognize or treat fractures, include:
- Complete medical history and physical examination
- Because of the abnormal movement that occurs in a limb at the fracture site, the diagnosis of a long bone fracture is usually very obvious. Your veterinarian will initially want to ignore the obvious fracture and evaluate your cat for other injuries. Some injuries (particularly those of the chest and spine) necessitate prolonged evaluation before any surgery is done.
- Thoracic radiographs (chest X-rays) are important in animals that sustain trauma. Potentially life-threatening pulmonary contusions (lung bruising) or pneumothorax (free air in the chest space from a small lung rupture) is frequently encountered in patients who have been involved with automobile accidents or other trauma. Many times patients suffering from pelvic fractures also have injury to the urogenital system. Abdominal radiographs (X-rays) or special studies involving the injection of dye or contrast material may be necessary to evaluate the kidneys, ureters and bladder fully.
- Blood tests may detect the presence of anemia or other problems related to shock. Blood gas and electrolyte tests enable your veterinarian to evaluate the metabolic status of your pet. Biochemical profiles look at the function of major organs, such as the liver and kidneys. These tests are helpful in assessing whether a patient is an acceptable risk to undergo anesthesia for definitive fracture repair.
- A Robert Jones-type padded bandage or a splint represents excellent methods to temporarily stabilize fractures of the radius/ulna (front leg) or the tibia (lower, back leg). This type of device can be used to prevent excessive motion at the fracture site while the patient is stabilized prior to definitive surgical repair. The “bulky” nature of this type of “pillow splint” provides support to these fractures and the damaged soft tissues around.
- It is important to realize that there may be more than one acceptable method for repairing a specific fracture. Often the experience of the surgeon determines the specific fracture repair.
A comminuted fracture is defined as one that has more than two major fracture fragments. These fractures are inherently unstable. Fractures involving a joint require specific repair methods that allow early motion in the affected joint. Forces act at fracture sites needing stabilization and occur in the direction of the bone, perpendicular to the bone (bending or shear) or around the bone (rotational or torsional).
Many factors come into play when deciding definitive fracture repair. The type of repair undertaken must stabilize distracting forces.
- Fractures that are inherently stable (such as a simple fibular fracture) may just require stabilization with a cast or splint. Using pins and wires is another method of stabilizaton.
- To provide additional support, a supplemental external skeletal fixator (ESF) can provide additional axial and rotational stability. Besides placing a pin internally within the marrow cavity, pins are placed through the skin and into the bone fragments. The pins are attached with a series of clamps and connecting bars to provide stability that is more rigid.
- Veterinarians have used bone plates and screws for the past 30 years. Plates and bone screws generally provide superior rigid stability to fractures but, many times, this is at the expense of the regional blood supply. Extensive dissection of the bone fragments is often necessary to achieve proper fixation. In recent years the trend among veterinary orthopedic surgeons is to dissect less tissue and provide an environment for “biologic fixation.” Many times fractures are fixed in a closed manner with an ESF as the definitive method of fixation. Generally, only minimal tissue dissection is required with these techniques.
- More recently, the use of interlocking nails has been used in veterinary orthopedic surgery. This technique employs a large intramedullary (within the bone cavity) “pin” that is modified to accept locking screws through the bone and nail both above and below the fracture. This provides very secure fixation with minimal tissue invasion.
Follow-up Care for Cats with Fractures
It is very important to follow your veterinarian’s instructions concerning postoperative care. Make sure all your questions are answered before leaving the hospital with your pet.
If your pet has had surgery performed, pay particular attention to the wound looking for excessive redness, swelling or discharge. Be sure to alert your veterinarian if any of these conditions occur.
Follow your veterinarian’s directions for follow up examinations. Radiographs (X-rays), are usually taken at 4 to 6 week intervals, until the bone is healed.
Physical therapy may be helpful in the early rehabilitative process, and your veterinarian should provide explicit instructions. Your veterinarian may have “prescribed” a certain amount of physical therapy following fracture repair. Many times the success or failure of a specific fracture is dependent on the type of aftercare provided.