Franklin Vets Blog

Lime’s triple whammy

August 25, 2021

Single injuries can be complicated. Multiple injuries are always complicated. They take longer surgery time have a higher infection rate, higher risk of failure, and of course if they involve multiple limbs can create real problems for post-operative mobility. Just getting to the toilet is a serious challenge when both your back legs have been repaired.

Lime the cat with multiple injuries

Lime

Lime is a young cat that came to see me at our Pukekohe clinic having sustained injuries to the rear end of the body, probably from an accident with a car. Lime had multiple fractures to the pelvis, including breaking through the sacroiliac joints on each side of the pelvis, which is where the pelvic girdle attaches to the spine.

Lime pelvic fractures and surgery

Red arrows show the two dislocations, yellow arrows show the fractures. 2 sacroiliac dislocations stabilised with a screw on each side.

As if this wasn’t enough, Lime had also severely damaged one of his hock (ankle) joints, tearing out all the ligaments, along with much of the soft tissue on both sides of the joint, leaving bones, tendons and joint completely exposed.

After stabilising Lime from the trauma of the injury we went to surgery.

The two sacroiliac dislocations were put back in a normal position and stabilised with a screw on each side. This is a bit more fiddly than it sounds. Not only does the bone have to be gently pulled back to where it should be, but the screw has to hit a spot on the sacrum (part of the spinal column) that is only about 4-5mm wide, with a screw that is 2.7mm wide, and about 20mm long. Then repeat from the other side of the pelvis, without the two screw ends hitting…
All this has to be done without damaging the blood vessels or nerves around the sacrum.
The fractures in the pelvis were left to heal by themselves.

The hock presented a different challenge. We opted not to repair the individual ligaments, but to stabilise the hock joint using a transarticular external skeletal fixator, then manage the wounds as open wounds until they healed. When the soft tissue was all healed, we would reassess the ligaments, as in cats there can be enough fibrous tissue form to replace the function of the ligaments without having to replace them.

Lime external fixationWhich turned out to be what happened. The wounds on the hock were treated with special dressings for the next few weeks until they had healed.

Four weeks after surgery, we cut the connecting bars on the frame around the hock and tested the ligamentous support. It held! So off came the frame, and Lime gradually returned to normal activity.

A nice outcome for a complicated case.

Paul Eason BVM&S MANZCVS (Surgery; Emergency and Critical Care Medicine) Clinic Manager, Pukekohe