pISSN : 2221-1012

International Journal of Natural Sciences (2019), 9(2):05-08

eISSN : 2221-1020
www.ijns.net

Successful surgical management of unilateral diaphyseal femoral and tibial

fracture in a cat
Bhajan Chandra Das1*, Sabiha Zarin Tasnim Bristi1, Sushyam Biswas1, Tuli Dey1 and Bibek
Chandra Sutradhar1
1
Chattogram Veterinary and Animal Sciences University, Chattogram -4225, Bangladesh

[Received: September 30, 2019; Accepted: December 22, 2019]

ABSTRACT
Pet cat population are gradually increasing in Bangladesh as well as simultaneously increasing the high rising
syndrome that is the major cause of multiple fractures in cat. There are various external and internal techniques
applied for different fracture management in cats all over the world. The present case study evaluates the
successful surgical management of unilateral diaphyseal femoral and tibial fracture in a cat. Approximate 1 year
old female 2.5 kg body weight local rescued cat was brought to Teaching Veterinary Hospital (TVH) with the
history of trauma in left hind limb of unknown cause. Clinical and radiological investigation confirmed that the
cat was suffered from unilateral left proximal diaphyseal overriding oblique femur fracture and distal diaphyseal
overriding transverse tibial fracture. Both fractures were closed. Neurological examination shown positive
conscious propioception (CP) and deep pain reflex. On the basis of clinical condition of cat and fracture patient
assessment score (FPAS), surgeon decided to orthopaedic surgery (intramedullary pinning) for correction of
fractures. The patient was prepared aseptically and surgery was performed as standard surgical procedure with
proper anaesthetic protocol. In case femur fracture correction, retrograde intramedullary pinning (IMP) was
performed with 2.0mm K-wire and one full cerclage wire with 22 gauze stainless steel orthopaedic wire and in
tibial fracture correction, same technique was done with 1.6 mm K-wire. Postoperatively patient was checked at
different interval and parameters were studied as lameness grade, functional limb outcome and fracture healing.
Mild weight bearing, implant in position and fracture gap were noticed at 16th post operative day. Full weight
bearing, functional limb outcome, bone healing and femoral pin migration were observed at 42th postoperative
day. Both pin were removed at same day. The cat maintained a joyful life and owner was very happy. The
present case study concluded that the retrograde IMP by K-wire can be used effectively for femur and tibial
fracture management in cat.

Keywords: Femoral and tibial fracture, Diaphyseal, Fracture patient assessment score, Conscious propioception,
Retrograde intramedullary pinning, K-wire.

INTRODUCTION long bone fracture repair, each of which has

Fracture of long bone is commonly encountered
orthopaedic problem in canine as well as in feline
practice. The incidence of long bone fractures is
50% of all feline fractures [1] and femur is one of
the most commonly fractured bones in dogs and
cats [2]. It is also found that 45% femoral fracture of
all long bone fractures and 28% femoral diaphysis
of all long bone fractures [3]. Another study reported
that maximum fractures in femur (42.86%)
followed by humerus (25.40%), radius and ulna
(20.63%) and tibia and fibula (11.11%) [4].
Unilateral femoral and tibial fractures in cats are
not very common. Fractures in cat are readily
diagnosed by palpation and radiography. In almost
all cases, surgical intervention is indicated to
reduce the fracture properly and provide stability.
A number of fixation methods are available for
advantages and disadvantages. Intramedullary
pinning is a popular method of long bone fracture
repair in cat [5] and virtually all types of fracture,
even severely comminuted fractures of the
diaphysis can be successfully treated by the use of
intramedullary fixation used in conjunction with
cerclage wires [6]. As the unilateral femur and tibial
fracture are rare, the objective of present case study
is to evaluate the surgical efficacy of femoral and
tibial fracture by intramedullary pinning.
MATERIALS AND METHODS
Case history and observation
The study was conducted at Surgery Unit, SA
Quadery Teaching Veterinary Hospital (SAQTVH)
in Chittagong Veterinary and Animal Sciences

*Corresponding author: bcdas2002@gmail.com

Int J Nat Sci (2019), 9(2):05-08
University (CVASU), Chittagong during June,
2019. Approximate 1 year old female 2.5 kg body
weight local rescued cat was carried to Teaching
Veterinary Hospital (TVH) with the history of
limping in left hind limb of unknown cause since
one week. No conservative or supportive treatment
was done before coming to hospital. Clinical
examination revealed that the patient was active,
alert and normal defecation, urination and no
external injury in the affected limb. Orthopaedic
examination on affected bone by inspection and
palpation showed non weight bearing (Fig.1), pain,
swelling and crepitation. Radiological
investigation was performed on ventrodorsal view
by using a digital x-ray machine (Shimadzu, Kyoto,
Japan) which confirmed that the cat was suffered
from unilateral left proximal diaphyseal overriding
oblique femur fracture and distal diaphyseal
overriding transverse tibial fracture (Fig.1).
Neurological examination found positive conscious
propioception ( which was performed while the cat
was standing with the limbs in a normal position,
the toes were turned over and released, in positive
CP reflex- the cat showed immediate return the toe
in normal position) and deep pain reflex (which is
performed by applying pressure on the toe web by
artery forceps). On the basis of clinical condition
of cat and fracture patient assessment score
(FPAS), surgeon decided to open reduction internal
fixation (ORIF) by intramedullary pinning with
ancillary fixation for both fractures correction.
Fig. 1: Left proximal diaphyseal overriding oblique
femur fracture and distal diaphyseal overriding
transverse tibial fracture
Anaesthesia and operative technique
The patient was off feed 6 hours before operation.
Under physical restraining, clipping and shaving
6
Das et al.
were done and the patient prepared aseptically by
using 7% povidone iodine and 70% alcohol. The
cat was sedated by xylazine hydrochloride @ dose
rate 1 mg/kg body weight intramuscularly and
general anaesthesia was performed by ketamine
hydrochloride @ dose rate 10 mg/kg body weight
intravenously with stable infusion connection. The
patient was positioned in lateral recumbency, the
affected limb dorsally. Through craniolateral
approach, a linear incision was done on the skin
and exposed the fractured femur bone (Fig.2) and
reduced the fractured bone anatomically. Fracture
fixation was done by retrograde intramedullary
pinning by 2.0 mm K-wire with one full cerclage
wire with 22 gauze stainless steel orthopaedic wire.
Surgical wound was closed as standard procedure
and then patient position was changed, the affected
limb in ventrally. Through medial approach, a
linear incision was done and exposed the both
fractured end (Fig.2) and immobilized the fractured
fragments by 1.6 mm K-wire. Closed the surgical
wound as standard procedure and protective soft
cotton bandage was applied from toe to thigh
region.
Postoperative care and advice
Postoperatively, antiobiotic (Ceftriaxone ) (
Renacefvet®,Renata Ltd, Mirpur,Dhaka)- five days
intramuscularly, pain killer ( Meloxicam
hydrochloride) (Melvet®, Acme Ltd, Savar,
Dhaka)- three days subcutaneously and
antihistaminic (Pheniramine maleate) (Alerin®,
SK+F Ltd, Tongi, Dhaka )-five days
intramuscularly were administered. Advice was
given to apply cold application in the affected area
for three days and restricted movement for two
weeks. Advice was given to the owner to keep dry,
neat and clean the surgical area and bring the
patient for follow up checkup at regular interval.
To evaluate the surgical efficacy of the patient, the
following parameters were analyzed at regular
interval-lameness grade, functional limb outcome,
fracture healing.
RESULTS
Postoperative day 1, x-ray revealed implant in situ
(Fig. 3), and day 16, clinically the patient exhibited
mild weight bearing and radiographic examination
revealed implant in position and fracture gap(
Fig.4). Full weight bearing (Fig.5), functional limb
outcome, bone healing and mild femoral pin
migration were observed at 42th postoperative day
(Fig.6) and both pin were removed at same day
(Fig.7).
Int J Nat Sci (2019), 9(2):05-08 Das et al.

Fig. 2: Through standard surgical approach, exposed the distal femur Fig.3: Postoperative day 1-implant in
fragment and proximal and distal fragment of tibia position

Fig.4: Postoperative day 16- Fig.5: Full weight bearing on Fig.6: Pin migration on postoperative
Implant in situ and fracture gap postoperative day 42 day 42
reduced

The cat maintained a very cheerful life and owner

was very happy. The present case study
concluded that the retrograde IMP by K-wire with
ancillary fixation full cerclage wire can be used
effectively for femur and tibial fracture
management in cat.

DISCUSSION
In present case study, femur fracture was found in
non-descriptive female cat approximate one year
age weighing 2.5kg. Fracture incidence is more in
non-descriptive cat (96.83%) than Persian cat
(3.17%) [4] Metropolitan city.

Another report found that fracture incidence is

Fig.7: Postoperative day 42-both pin removed
and healing noticed
more in six to twelve months of age (35.6%)
followed by above three years (20.1%) and one to
two years (18.0%)[7] probably because such
breed formed a major portion of the cat population
in Metropolitan city. Another report found that
fracture incidence is more in six to twelve

7
Int J Nat Sci (2019), 9(2):05-08
months of age (35.6%) followed by above three
years (20.1%) and one to two years (18.0%)[7].
This was probably because most of the cats were
managed intensively up to three months of age and
as they were allowed to move freely after about
three months of age, then they were more prone to
road traffic accidents.
The unilateral femoral and tibia fracture was
performed by intramedullary pinning with K-wire.
Selection of K-wire or Steinmann pin is very
important for intramedullary pinning. Selection of
the appropriate pin depends on the size of the
intramedullary cavity, the bone being repaired, the
fracture configuration and whether ancillary
methods of fixation are to be used. Pin diameters of
1.6 mm to 4.8 mm are suitable for use in most cats
and it should be big enough to fill at least 60 to
70% of the medullary cavity at its narrowest point.
Larger pins provide greater resistance to bending
forces and are preferred in straighter bone [1]. In
present case study, femoral fracture repaired by
intramedullary pinning, cat showed gradual weight
bearing and functional limb outcome was observed
at 42 day postoperatively. Pin migration and non-
union are common complications in intramedullary
pinning. The incidence of non-union is 5.2%
(18/344) [8] and 16.66% (2/12) [9]. Another study
observed a very low 0.85% (2/233) incidence of
non-union[10] but in present case study there was
no non-union. Pin migration was noticed at 42nd
postoperative day. In one study reported that two
pin migration out of six cats [11]. The present
study concluded that intramedullary pinning is an
easy and effective method for long bone fracture
management in cat. Post operative morbidity
depends on the appropriate pin selection and post
operative care.
ACKNOWLEDGEMENTS
The authors are grateful to the pet owner for well
cooperation by providing valuable information and
postoperative follow up until patient recovery.
Das et al.
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