Bone Pinning Treatment of Dexter Bicondylar Femoral Fracture

in Persian Cat at Jakarta Animal Hospital

Riesky Nudialestari
Veterinary Profession Education, Faculty of Veterinary Medicine, Universitas Brawijaya

Abstract : Femur fracture is a frequent case of fractures in cats. Case fractures in cats can be caused by
direct trauma, indirect trauma, muscle contraction and pathological conditions. Clinical sign that usually
seen are local trauma, crepitus, abnormal posture or limb positioning, dysfunction and pain. This final
project report aims to understand the etiology, clinical sign, differential diagnosis, diagnosis and
handling of fractures in cats. In this case, a one-year- Persian cat is brought to the Jakarta Animal
Hospital with suspicion of fracture to the dexter hind limb, accompanied by swelling, contusions and
lacerations on the lateral part. The results of physical examination showed normal temperature, ie 38.2
˚C, skin turgor <2 seconds, CRT <2 seconds, responsive facial expression, presence of pain in dexter
hind limb with swelling, contusions and laceration ± 1 cm. The x-ray results showed continuity break
in distal of Os. Femur dexter. The haematological results indicate leukositosis unsignificant. Based on
the signalement, anamnese, physical, and further examination the cat is diagnosed with a bicondylar
fracture Os. Femur dexter with dubius-fausta prognosis. Bone pinning treatment was perform along
with Asering as fluid therapy, analgesics (Tramadol 2 mg/kg), and antibiotics (Ceftriaxone 25 mg/kg).
Post-surgery cat undergo physical rehabilitation to reduce their activity. Eleven days post-surgery, the
cat has begun to set foot and walk slowly.

Keyword: Cat, fracture, Os. Femur, bone pinning

Introduction Case History

One of the most common diseases in cats or
dogs is bone fracture. Fractures in cats,
commonly caused by trauma such as bumping
hard objects, get hit by a vehicle and fall from a
high place. Most cats have fractures of long
bones such as fracture of the femur, humerus,
radius, ulna, tibia and fibula. A case of fracture
with the highest incidence rate in cats is the
femoral fracture1. Recorded as much as 6.9% of
cats have an femoral fracture, followed by
fracture of Os. Tibia (3.5%), Os. Humerus
(1.5%), and Os. Radius / Ulna (3.1%). The
incidence of this fracture is most common in
young cats less than 1 year old.
Treatment of fractures in long bones should be
done immediately because it can interfere with
the convenience of pet walking and the process
of bone formation and body posture. This paper
reports a case of bicondylar femoral fracture
that resolved by bone pinning at Jakarta Animal
Hospital.
A 1 year old female Persian cat weighting 2,4
kgs, named Piper was presented to the Jakarta
Animal Hospital. The owner suspected that the
patient had fracture in her right hind limb,
because it’s showed swollen, contusio and
laceration. There was no history about traffic
accident before.
Clinical Sign
Clinical examination revealed trauma on the
right hind limb, indicated by dark red, swollen
thigh muscles and fragmen of Os Femur can
seen from the laceration. The cat felt pain when
the affected thigh (femoral area) was palpated.
The patient also exhibited leg carrying
lameness. Physiological parameters
(temperature, heart rate and respiratory rate)
were within the normal range. The cat was
positioned anteroposterior and lateral for
radiographic examination. The radiograph
showed an complete bicondylar femoral
fracture (Fig. 1). Hematology examination only
showed unsignificant leukositosis.
Leukocytosis in this case may causes by
inflamation of trauma. The cause of
leukocytosis can be a normal reaction to
external stimulation of infection, inflammation,
stress, drugs and haemolytic anemia1.
bone holding forceps aligned as close to normal
anatomical position as possible. The fracture of
shaft fragment were stabilized using
intramedullary pins that placed in a retrograde
fashion (Fig. 3). Then the condylus also
stabilized using intramedullary pins using the
hand drill from lateral condylus to medial. The
surgical site was irrigated using sterile saline
solution and antibiotics Penicillin was given
around operation site. The surgical site closed
in 4-layers: muscles along with tensor fascia
lata were apposed using number 3/0, vicryl in a
simple interrupted suture pattern. The
subcutaneous tissue was apposed using number
3/0 vicryl in a horizontal mattress pattern.

Figure 1. Anteroposterior and lateral view of the

left femur showing complete bicondylar femur
fracture.

Surgical
The cat was induced for general anesthesia
using Zoletil (3 mg/kg), injected intravenous. Figure 2. Incision is made along the craniolateral.
The entire right hind limb prepared for aseptic
surgery by shaving, scrubbing using alkohol
70% and application of Povidone iodine 3% on
the skin. Endotracheal tube was placed for
delivery of oxygen and Isoflurane (1,5-2,5%) to
maintain anesthesia following induction.
Following draping, a lateral approach to the
femur was used to expose the fracture
fragments.
Surgery was started with an incision (5 cm) Figure 3. Stabilized using intramedullary pins.
along the craniolateral border of the thigh. The
incision is made slightly more cranial than To make sure the position of intramedullary
lateral because the exposure plane will be at the pins after the surgery, patient got the
cranial border of the biceps (Fig. 2). Incise the radiographic examination (Fig. 4).
superficial leaf of the fascia lata along the Intramedullary pins was confirmed fit the
cranial border of the biceps femoris muscle for position and the remaining pins was cut off.
the length of the incision. Retract the biceps
Postoperative Care
femoris caudally to expose the vastus lateralis
Postoperative care involved light Roberts Jones
muscle. Incise the fascial septum of the vastus
bandage to minimize swelling and to
lateralis as it inserts at the caudal lateral border
immobilize the limb. Along with fluid therapy
of the femur. Reflect the vastus lateralis from
with Asering, intravenous injection of
the surface of the femur to expose the femoral.
Fracture fragments were repositioning with analgesic agent Tramadol (2 mg/kg) given
once immediately after surgery and continued
for 4 days after surgery. Also intravenous
injection of antibiotic Ceftriaxone (25 mg/kg)
for 10 days. Movement was also restricted.
Figure 4. Anteroposterior and lateral view of the
left femur after surgery.
Discussion
Fractures in cats are often caused by trauma due
falling from a height or being hit in an
accident2. Because the patient did not play
outside the house during the incident, the
biggest suspicion was due to fall from a height.
The diagnosis based on clinical examination
and radiographic examination that showed an
complete bicondylar femoral fracture.
Bicondylar femoral fracture is fracture that
occure in the distal part of Os Femur, precisely
supracondylar fracture that accompanied with
intracondylar fracture3. Incidence of
supracondylar and intercondylar fractures in
cats occurred in 60.7% of total cases of femoral
fractures4. Treatment that perform was internal
fracture fixation using intramedullary pins.
The prognosis of this case is dubius-fausta.
Fracture conditions in young animals tend to
have a high cure rate or fausta. However in this
case the fracture occurs in the distal part of Os.
Femur, this complicates the condition of bone
healing because the bone that can withstand
very short fixation. So the selection of surgical
measures in reducing and fixing bone becomes
a very important part, supported by good
postoperative care management.
Classically, the methods of internal fracture
fixation involve the use of pins, wires, screws,
and plates to rigidly stabilize fractures that have
been anatomically reduced5. The selection of
internal fixation implant is based on multiple
mechanical, biologic, and clinical parameters
associated with each patient and fracture, and
not just the fracture pattern itsel6.
Intramedullary pins are used for internal
fixation as a primary method of stabilization,
but are used more frequently in combination
with wires, bone plating, or external skeletal
fixation7.
The basic postoperative care management is to
prevent infection, reduce the pain, and to
increase healing process. The antibiotic that
used in this case was Ceftriaxone and
Tramadol was also given as a pain control.
The bandage should be observed twice a day for
evidence of odor or swelling and bandage
should be kept clean and dry. Activity should
be restricted to leash walking and physical
rehabilitation until the fracture has healed8.
In this case, Robert-Jones bandage was choosen
to minimize swelling and to immobilize the
limb. Physical rehabilitation encourages
controlled limb use and optimal limb function
after fracture healing. Care must be taken to
develop customized protocols for each patient
depending on location of the fracture, stability
and type of fracture fiation, potential for
healing, abilities and attitudes of the patient,
and willingness or ability of the client to
provide for the animal’s care. Postoperative
radiographs are taken to evaluate fracture
reduction and implant location8.
Asering was administrated intravenously for
body fluid maintenance during surgery and as
post-operative. There was no complication
reported after the surgery. The surgical wound
progressively healing. At 8 days after surgery,
the cat was started to learn using the leg and at
11 days he started walk but not for full weight
support.
Conclusion
Based on history, clinical sign and radiographic
examination, bicondylar femoral fracture was
confirmed. Bone pinning (intramedullary pins)
was performed. Postoperative care
management gave good resolution in wound
healing and patient showed proggresive
development without any complication was
reported.
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