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/)
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, ยผ 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
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
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.
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#11, and biceps femoris muscle was retracted using muscle retractor.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.
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)
48. โข Unilateral body of ilium + contralateral
sacroiliac joint + pubis and ischium = 17 %
โข Unilateral body of ilium + pubis of ischium =
13%
โข Sacroiliac joint + pubis of ischium = 13%
โข 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
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
ย http://emedicine.medscape.com/article/825869-overview#a4
LANZ OI: LUMBOSACRAL AND PELVIC INJURIES.ย VET CLIN NORTH AM SMALL ANIM PRACTย 32(4):949-962, 2002.
BOOKBINDER PF, FLANDERS JA: CHARACTERISTICS OF PELVIC FRACTURE IN THE CAT.ย VET COMP ORTHOP TRAUMATOLย 5:122-127, 1992.
WARD GW: PELVIC SYMPHYSIOTOMY IN THE CAT: A STEEL INSERT TO INCREASE THE PELVIC DIAMETER.ย CAN VET Jย 8(4):81-84, 1967.
2. Words change to yellow!
Pic bigger n ref
Trans-acetobular fracture & bilateral sacroiliac luxation should include or not
Find the normal one!!!!!!!!!!!!!!!!!!!!!!
Zoom in!
Put no
Radiograph repeated- insert
Because the ABU is normal, patient started to use its hindlimb although not fully.
Compare to case
http://www.vetfolio.com/emergency-medicine/managing-feline-obstipation-secondary-to-pelvic-fracture
For my case, it was categorised as in type 1, which is 17%
(Mills, J & Wittingham A. 2013) http://www.vettimes.co.uk/article/pelvic-fractures-management-treatment-and-complications/
Burger tu dari fossum: Burger M, Forterre F, Brunnberg L: Surgical anatomy of the feline
sacroiliac joint for lag screw fixation of sacroiliac fractureluxation,
Vet Comp Orthop Traumatol 17:146, 2003.
The pelvis is a good biological environment for fracture healing.