surgery of multiple pelvic fracture in cat

1. Muhammad Aqmal Hakim Bin Mazlan (160702)
Supervisor: Dr Loqman Mohamad Yusof
Multiple Pelvic Fracture
Repair in a Cat

2. Introduction
Case Report
Discussion
Conclusion

3. Introduction

4. 1. Pelvic fracture is a disruption of the bony
structures of the pelvis.
(Crawford Mechem, 2015)
2. Pelvic fractures account for approximately 25%
of all fractures in cats.
(Olmstead 1998 & Piermattei 2006)
3. Most feline pelvic fractures are mechanically
unstable because the pelvis typically sustains
multiple fractures simultaneously, including
fractures of a weight-bearing region
(Sara A. et al 2005)

5. Anatomy of the pelvic
(Source: http://www.webecon.bris.ac.uk/calnet/)

6. (Source: http://www.webecon.bris.ac.uk/calnet/)

7. Case Report

8. ID Roxy
Age 9 years old
Sex Castrated Male
Breed Maine Coon X
Weight 3.6 kg
Vaccination Unknown
Deworming Unknown
BCS 3/5
Patient Signalment

9. History
Trauma.
Hospitalized at
private vet and
fluid drips given.
RadiographVD
and lateral view
was taken
Referred to UVH21st February
25th February

10. T: 37.8 degree P: NT R: 30 bpm
BAR
Pale Mucous Membrane
Skin Full of Fleas
CP positive, pain positive for both hindlimb
Physical examination

11. Radiological
finding
Radiological
diagnosis
Pubis symphysis
separation
Pubis symphysis
fracture
Radiograph on 21st February
Right lateral view
Normal

12. Ventrodorsal view
Radiograph on 21st February
Radiological findings Radiological Diagnosis
Bilateral sacroiliac junction
displacement
Bilateral sacroiliac luxation
Discontinuity at the right
trans-acetabular region
Transacetabular Fracture
Pubis symphysis separation Pubis sysmphysis fracture
Discontinuity at the left wing
of ilium
Iliac fracture
Normal

13. Problem Final Diagnosis Plan of treatment
Bilateral sacroiliac
luxation
Multiple pelvic fracture Radiograph of pelvic
Open reduction and
fixation surgery
RightTransacetabular
fracture, pubis fracture,
and ischial fracture
Severe flea infestation Flea infestation Deticking
Problem list

14. Problem Medication Indication
1) Multiple pelvic
fracture
Tramadol 3mg/kg, ¼ tab
PO,TID
As an analgesics to
alleviate the pain
Serrratiopeptidase
(Danzen) 1tab PO BID
Anti-inflammatory to
relieve the swelling due
to trauma
Lactulose 1ml PO BID To facilitate defecation
Marbofloxacin
(Marbocyl) 2mg/kg
0.72ml, IV, SID
To prevent bacterial
infection
Meloxicam (Metacam)
0.1mg/kg, 0.07ml SQ SID
Alleviate post-operative
pain and inflammation
following surgical
procedures e.g.
orthopaedic and soft
tissue surgery
Peri-operative treatment

15. Problem Medication Indication
2) Flea infestation Frontline spot on To eliminate flea and
prevent re-infestation

16. Radiograph on 9th March 2016 (Pre-
surgical Radiograph)
There is more obvious separation
on the left iliac bone, and the
bilateral sacroiliac luxation
displacements reduced

17. • Premedication: Tramadol 5mg/kg, 0.22ml, IV
• Induction: Thiopental, 12.5 mg/kg, 0.9 ml,
IV
• Maintenance: Isoflurane 2-3%
Anaesthetic protocol

18. SURGICAL PROTOCOL

20. Skin preparation:The patient was clipped
from last rib and continue posteriorly on
both sides

21. 6cm skin incision was done horizontally from iliac crest and
caudally beyond greater trochanter with #20 scalpel blade

22. Blunt dissection was made using Mayo scissors through
the subcutaneous tissue and gluteal muscle.
HeadTail

23. Head
Tail
Middle and deep gluteal muscle and long heads of tensor fasciae
muscles were retracted using muscle retractor to expose the bone
fracture.

24. Head
Tail
Soft callus was scrapped using freer elevator

25. Head
Tail
18G needle was used to make four opening through the ilium
bone, on both side of the fracture

26. Head
Tail
Two cerclage wire size 0 were inserted through the
needle

27. Head
Tail
The cerclage wire were tightened using twisting forceps.The extra wire
were cut using wire cutter and the end was bend towards the bone

28. HeadTail
Muscle layer, gluteal fat and subcutaneous tissue was closed
using simple continuous suture pattern using 3-0 vicryl

29. HeadTail
Lastly,skin closure was closed using 3-0 ethilon with simple
continuous suture pattern

31. Head
Tail
Skin incision was made vertically from dorsal greater trochanter,
to ventral greater trochanter using scalpel blade #20

32. Head
Tail
Subcutaneous and gluteal fat layer was incised using scalpel blade
#11, and biceps femoris muscle was retracted using muscle retractor.
Superficial gluteal muscle was incised using #11 blade.

33. Head
Tail
Joint capsule was incised using #11 scalpel blade to expose femoral
head, and periosteal elevator was used to elevate the femoral head

34. Head
Tail
Chisel and hammer was used to osteotomised the femoral head
and neck.The periphery of the bone was smoothen using famon
rasp.

35. Head
Tail
Acetabular fracture was located using periosteal elevator and
bone holding forceps was used to bring the fracture part
together.

36. 18G needle was used to make an opening on both side of the
fracture, and cerclage wire was inserted through the needle.

37. HeadTail
The cerclage wire was twisted and tightened digitally and using
twisting forceps.The excess wire was cut and bend towards the
bone.

38. HeadTail
Muscle layer was closed using 3-0 vicryl suture material with simple
continuous suture pattern. Gluteal fat and subcutaneous layer was
closed using intradermal suture pattern with 3-0 vicryl.

39. Head
Tail
Skin incision was done using 3-0 ethilon with simple continuous
suture pattern.

40. R

41. L

43. Radiological Finding Radiological diagnosis
Presence of two
cerclage wire at ilium
wing
Reduction and fixation
iliac fracture and trans-
acetabular fracture
Presence of one
cerclage wire at
acetabulum bone
Pubis symphisis
separation
Pubis symphysis
fracture
Absence of right
femoral head and neck
Complete excision of
femoral head and neck

44. Progression 14th March (Day 5 post
surgery)
Quiet and responsive
ABU normal
In sternal recumbency
Able to urinate and defecate well form feces
Surgery site dry and clean
Discharged on 14th March 2016 ( 5 days later)

45. Good
Prognosis

46. Discussion

47. Treatment
options
Common
types of
pelvic
fractures

48. • Unilateral body of ilium + contralateral
sacroiliac joint + pubis and ischium = 17 %
• Unilateral body of ilium + pubis of ischium =
13%
• Sacroiliac joint + pubis of ischium = 13%
• Bilateral sacroiliac luxations + pubis and ischium
= 9%
Common types of pelvic fracture
(www.vetfolio.com)

49. Treatment Options
(Burger, M. et al 2003)
Treatmentoptions
Surgical
Lag Screw
Bone Plating and
Screw
Conservative
Analgesia
Urinary
management
Cage rest
Physiotheraphy
(Mills, J & Wittingham A. 2013)

50. Provides compression and
tightening at fracture sites.
Placement of implants is difficult
due to size of the patient
Surgical
Lag screw
Bone Plate and
Screw
Provide extra holding anchor at
the fracture site
Placements of implants is
difficult due to size of the
patient

51. Analgesics Urinary
management
Cage rest Physiotheraphy
Conservative

52. Conclusion

53. This is a case report of a cat that was diagnosed with
multiple pelvic fracture, where it was successfully
managed surgically.
The decision to treat pelvic fractures surgically or
conservatively is based on a combination of radiographic
evaluation, physical examination findings, and
client/patient factors. (www.vettimes.co.uk)
Surgical and conservative approach are both required to
maximize functional outcome, relieve discomfort, and
accelerate return to activity.

54. DR LOQMAN HJ MOHD
YUSOFF
SAWVO AND STAFF
MY FAMILY
ROTATION GROUP 4
DVM 5 2011/2016
AUDIENCES
Acknowledgement

55. Thank you