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Figure 1—Ventrodorsal (A) and lateral (B) radiographic views of the

pelvis and hip joints of a 1.5-year-old cat with a 6-week history of
altered gait and bilateral hind limb lameness with signs of pain and
crepitus localized to the right hip joint.

History
A 1.5-year-old neutered male British Shorthair cat was evaluated because of a 6-week history of reluctance to
walk. The cat was ambulatory but had mild bilateral hind limb lameness, worse on the right side. Signs of discom-
fort and crepitus on extension of the right hip joint were noted. Standard radiographs of the pelvis and hip joints
were obtained under sedation with the cat’s hind limbs in extension (Figure 1).

Determine whether additional imaging studies are required, or make your diagnosis from Figure 1—then turn
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This report was submitted by Mark J. Longley, BVM&S, and William G. Marshall, BVMS; from the Department of Surgery, School of Veterinary
Medicine, University of Glasgow, Glasgow, G61 1QH, Scotland. Dr. Longley’s present address is Pool House Veterinary Hospital, Fosseway Ln,
Lichfield, Staffordshire, WS13 8JY, England.
Address correspondence to Dr. Longley (mark.longley1@btopenworld.com).

JAVMA, Vol 242, No. 3, February 1, 2013 Vet Med Today: What Is Your Diagnosis? 315
Figure 2—Same ventrodorsal image as in Figure 1. Osteolysis af-
fects the dorsal aspect of both femoral necks (white arrowheads).
There is a degree of sclerosis of the proximal femoral epiphysis on
the right side, which contrasts with an area of osteolysis affect-
ing the adjacent metaphysis. This gives the impression that the
epiphysis has separated from the metaphysis (black arrowhead).
Radiographic Findings and Interpretation
On the ventrodorsal image, areas of osteolysis affecting
the dorsal aspect of both femoral necks are evident. A degree
of sclerosis of the proximal femoral epiphysis on the right
side contrasts with an area of osteolysis affecting the adjacent
metaphysis. This gives the impression that the epiphysis has
separated from the metaphysis (Figure 2). Interpretation of the
lateral image is limited by superimposition of the hip joints.
A ventrodorsal radiograph of the pelvis and hip joints
was taken with the hind limbs in a flexed, or frogleg, position
(Figure 3). The flexed ventrodorsal image reveals bilateral
proximal femoral physeal fractures in addition to the me-
taphyseal osteolysis seen on the standard ventrodorsal image.
These findings are consistent with feline metaphyseal oste-
opathy or capital femoral physeal dysplasia.
Treatment and Outcome
The cat of the present report was treated by simultaneous
bilateral femoral head and neck excision, and at reexamination
1 month after surgery, no signs of lameness were evident.
Comments
The use of only standard ventrodorsal and lateral pro-
jections of the hip joints may lead to a proportion of femoral
neck fractures being missed. The flexed ventrodorsal, or frog-
leg, view provides an alternative view of the proximal portion
of the femur because the positions of the greater and lesser
trochanters and physis are altered. The flexed ventrodorsal
view has been shown to be useful in identifying fractures that
are not visible on the standard radiographic images of the hip
joints.1 The use of the flexed ventrodorsal view is advisable
in cases where findings on standard radiographic images are
equivocal and where clinical examination is suggestive of path-
ological changes of the hip joint. The flexed ventrodorsal view
is also useful where extension of the patient’s hip joints would
be painful. Positioning is straightforward, with the patient in
dorsal recumbency; the hind limbs are flexed cranially in a re-
laxed abducted position. The hind limbs must be positioned
316 Vet Med Today: What Is Your Diagnosis?
Figure 3—Flexed ventrodorsal, or frogleg, view of the pelvis and
hip joints of the same cat as in Figure 1. In addition to the metaphy-
seal osteolysis seen on the standard ventrodorsal image, bilateral
proximal femoral physeal fractures are evident (arrowheads).
symmetrically to allow comparison of radiographic findings
between the hip joints.2
Feline metaphyseal osteopathy or capital femoral physe-
al dysplasia was first described in 1994.3 Seen predominantly
in young overweight male cats, the condition is characterized
by pathological fracture of the femoral neck. In most cases,
there is no history of trauma, and the disease often affects
both hip joints. Not uncommonly, cats initially with unilat-
eral disease go on to develop the condition in the other hip
joint some months later. Radiographic signs may include loss
of definition of the femoral neck, radiolucency within the
femoral neck, or a radiolucent line across the femoral neck,
and in some cases, the femoral head can be seen to have
slipped. The latter 2 findings are diagnostic for separation of
the femoral head.3
Several etiologies have been suggested for physeal dys-
plasia, including trauma, avascular necrosis, and osteomy-
elitis. More recently, histologic studies4 have suggested that
there may be an underlying abnormality of the physeal car-
tilage. It has also been suggested that the fracture may be the
primary lesion and that the osteolytic changes seen radio-
graphically and histologically may occur secondary to this.5
Most cats with clinical disease are beyond the age at which
physeal closure would be expected to have occurred. Early
neutering has been shown to delay the closure of growth
plates in male cats, and this has been suggested to play a role.6
1. Rendano VT, Quick CB, Allan GS, et al. Radiographic evaluation of the
femoral head and neck fractures: the value of the flexed ventrodorsal and
oblique projections in diagnosis. J Am Anim Hosp Assoc 1980;16:485–
491.
2. Biery DN. The hip joint and pelvis. In: Barr FJ, Kirberger RM, eds. BSAVA
manual of canine and feline musculoskeletal imaging. Quedgeley, Glouces-
ter, England: British Small Animal Veterinary Association, 2006;119.
3. Chandler ED, Gaskell CJ, Gaskell RM, eds. Feline medicine and therapeu-
tics. 2nd ed. Oxford, England: Blackwell Scientific Publications, 1994;132.
4. Craig LE. Physeal dysplasia with slipped capital femoral epiphysis in
13 cats. Vet Pathol 2001;38:92–97.
5. McNicholas WT Jr, Wilkens BE, Blevins WE, et al. Spontaneous femoral
capital physeal fractures in adult cats: 26 cases (1996–2001). J Am Vet
Med Assoc 2002;221:1731–1736.
6. Queen J, Bennett D, Carmichael S, et al. Femoral neck metaphyseal
osteopathy in the cat. Vet Rec 1998;142:159–162.
JAVMA, Vol 242, No. 3, February 1, 2013